连续170例冠状动脉旁路移植术治疗冠心病

Consecutive 170 coronary artery bypass graftings in the treatment of coronary artery disease

目的 回顾应用冠状动脉旁路移植术 (CABG)治疗冠心病的早期效果和经验。方法 170例 (男 15 2例 ,女 18例 ;年龄 35～ 80岁 ,平均 6 6 7岁 )冠心病病人中 97%为多支冠状动脉病变。 81例左室射血分数≤ 45 % ,其中 2 1例 <30 %。 84%病人心绞痛CCSIII～IV级。除 1例在左前外侧小切口非体外循环下手术 ,余均为正中开胸低温体外循环下CABG。 41例采用左乳内动脉与左前降支搭桥 ,余均为大隐静脉桥。同期行心脏瓣膜手术 10例 ,激光心肌打孔 4例。 3例需主动脉球囊反搏支持。人均搭桥3 13支。结果 连续 170例CABG取得了良好的临床效果 ,无手术死亡。术后 94%的病人心绞痛完全消失。结论 CABG是治疗冠心病的一种安全和有效的方法 。

Objective To retrospectively review the experience and early clinical results of coronary artery bypass grafting (CABG) in the treatment of coronary artery disease. Method CABG was performed on 170 consecutive patients (152 male,18 female), age ranged from 35 to 80 years (mean,66.7 years). 97% of them had multiple coronary vessels disease. Left ventricular ejection fraction (EF) were equal to or lower than 45% in 81 patients and less than 30% in 21 patients among them. 84% of patients had class III or IV preoperative angina. All patients received CABG through middle sternotomy under cardiopulmonary bypass (CPB) except one who received minimal invasive direct coronary bypass without CPB. The average number of grafts were 3.13 and the infernal mammary artery were used in 41 patients and the saphenous veins in 129. Post-operatively intraaortic balloon pump was required in 3 cases. Result There was no operative mortality. All patients recovered and were discharged. 94% of patients are angina free and 6.0% patients in class I-II angina at a mean follow up period of 14.8 months. Conclusion CABG is a safe and effective way for the treatment of coronary heart disease with acceptable morbidity and mortality.