急诊冠状动脉搭桥术在急性心肌梗死治疗中的临床应用

Clinical application of emergency coronary artery bypass grafting in treatment of acute myocardial infarction

目的探讨急性心肌梗死（AMI）行急诊冠状动脉搭桥术的手术指征及外科处理要点，提高手术成功率。方法回顾性总结我院对2007年8月至2010年6月间急性心肌梗死患者行急诊冠状动脉搭桥术20例患者的临床资料，分析急诊冠状动脉搭桥术在AMI治疗中的临床应用。结果本组16例抢救成功，手术成功率为80％。非停跳搭桥11例，停跳搭桥9例，平均移植血管桥（2．8±0．5）支，使用主动脉内气囊反搏装置（IABP）8例；术后机械通气平均（18±14）h；术后低心排血量2例，难治性心律失常2例，脑血管意外1例，下肢感染1例。全组无一例发生围术期心肌梗死，无再次手术止血。平均随访时间为（15±3．4）个月，仅1例术后2个月反复出现右心功能衰竭症状，余患者心绞痛症状均完全消失，术后复查超声心电图示左室收缩功能明显改善。结论急诊冠状动脉搭桥术治疗急性心肌梗死可取得良好的疗效。

Objective To investigate the surgical indications and surgical treatment points and to improve the success rate in treatment of acute myocardial infarction （AMI） by emergency coronary artery bypass grafting（ECABG）. Methods Review the clinical data and analysis the clinical application of twenty patients with AMI who received ECABG from August 2007 to June 2010. Results Sixteen cases were survived, operative mortality was 20%. The average graft transplantation was 2.8 ± 0.5,11 cases with OPCABG,9 cases with ONCABG, IABP use in 8 cases. Mean intubation time was （18 ± 14）h,low cardiac output syndrome in 2 cases, refractory arrhythmia in 2 cases, cerebrovascular accident, lower limb wound infection in 1 case for each. The mean follow - up period was （ 15 ± 3.4 ） months. Angina disappeared in all patients postoperatively except one case with refractory right heart during follow -up. Echocardiography follow - up study revealed improved left ventricular function. Conclusions ECABG can achieve rather good therapeutic effects on AMI.