低射血分数患者非体外循环下冠状动脉搭桥术的应用

Off-pump coronary artery bypass grafting in patients with low ejection fraction

目的总结分析30例心脏超声检查射血分数〈30％的冠心病患者进行非体外循环冠状动脉搭桥术（OPCAB）的临床效果。方法2003年1月至2010年1月进行选择性OPCAB手术30例，全部经心脏超声检查测定射血分数为25-30（25．3±6．1）％。有心梗史23例，急性心肌梗死后1个月内6例，不稳定型心绞痛19例；心功能Ⅱ级7例、Ⅲ级18例、Ⅳ级5例。冠状动脉造影提示双支病变3例、三支病变21例、左主干6例。结果全部病例均完成OPCAB手术，平均远端吻合口（3．6±0．7）个，使用主动脉内球囊反搏3例。无死亡病例。有3例术后出现急性左心衰、低心排综合征，安放主动脉内球囊反搏后保守治疗好转。2例患者术后出现室颤，均复苏成功。结论低射血分数患者实施OPCAB手术有良好的可行性。

objective Analysis of 30 cases of patients underwent off-pump extracorporeal circulation coronary artery bypass surgery （OPCAB） with coronary heart disease and ejection fraction〈30%. Methods From January 2003 to January 2010, 30 cases of left ventrieular ejection fraction 25 to 30（25.3±6.1 ）% underwentselective OPCAB surgery were selected. 23 cases has a history of myocardial infarction, of that 6 cases with acute myocardial infarction within one month, 19 cases with unstable angina. Heart function Ⅱ level 7 cases, Ⅲ 18 cases, IV grade level 5 cases. 3 cases were double lesions, 21 cases with three lesions, 6 cases with left main lesion proved by coronary angiography. Results All patients were complete OPCAB surgery, the average distant end anastomosis was （3.6±0.7）, intraaortic balloon counterpulsation was used in 3 cases. No death. Three cases has acute heart failure and left cardiac output syndrome postoperation, and improved after planted intraaortic balloon counterpulsation, 2 patients with ventrieular fibrillation were resuscitation successful. Conclusion OPCAB surgery is feasible in low LVEF patients.