冠状动脉旁路移植术后二次开胸止血67例

Clinical analysis of reoperations for 67 bleeding patients after coronary artery bypass I

目的探讨冠状动脉旁路移植术（CABG）术后二次开胸止血的相关危险因素及出血的常见部位。方法2000年1月至2011年7月期间行CABG术2765例，发生二次开胸止血67例（占2．4％），对相关危险因素进行单因素分析并总结常见的出血部位。结果应用乳内动脉、术前停用抗血小板药物〈5天、合并有高血压、CABG＋其他手术、年龄〉70岁等，是引起术后二次开胸止血的危险因素（P〈0．05）。与是否体外循环下冠状动脉旁路移植、IABP的应用、合并糖尿病、旁路移植的支数无相关性（P〉0．05）。48例出血部位明确，依次是：乳内动脉及其创面、静脉旁路血管、胸骨、升主动脉插管口、胸腺窝、膈肌切口、钢丝孔。结论术前充分准备、尽可能避免相关危险因素、术中止血操作仔细，可减少术后出血的发生。

Objective To investigate the common sites and risk factors of reoperation for bleeding after coronary artery bypass grafts （CABG）. Methods During Jan 2000 to July 2011,2765 CABG procedures had been done in our hospital, in- cluding 874 cases with CABG by cardiopulmonary bypass , 1891 cases with off-pump coronary artery bypass grafts （OPCAB）, 105 cases combined with other procedures （cardiac valve operation, resection of ventficular aneurysm, et al）, 216 cases ap- plied intra-aortic balloon pump （IABP） ）. 67 patients needed reoperation for bleeding, the morbidity is 2.4%. Factors that might affect the result of reoperation were analyzed by single-factor analysis. Results The following factors were related to high rates of reoperation （ P 〈 0. 05 ） ： the internal marmnary artery （IMA） used, antithrembotic medication discontinued less 5 days before elective surgery, concurrent hypertension, combined with other surgery procedures and ages 〉 70 years. It was not sig- nificantly related to CABG or OPCAB, if use of IABP , if concurrent diabetes, number of grafts inserted. Major sources of bleeding found in 48 patients were the tMA and its vessels bed, vein grafts, sternum, aortic faucet, midriff, thymus gland bed vessels. Conclusion Prepared satisfactorily before operation , avoid risk factors can reduce reoperation for bleeding, but the most important is the operation carefully during operation of hemostasis.