1150例不停跳冠脉搭桥术临床经验总结

Analysis early and mid-term outcomes of 1150 consecutive cases after off-pump coronary artery bypass grafting: a single-center,11-year experience

目的总结不停跳冠脉搭桥术的临床经验,评价其疗效和安全性。方法回顾性分析首都医科大学附属北京友谊医院2001年1月至2011年12月收治的1150例不停跳冠脉搭桥术患者的临床资料。结果住院死亡13例,死亡率为1.13%。平均搭桥(3.25±0.30)支,平均手术时间(329.2±53.5)min,左乳内动脉使用率为94.0%。术前预防性使用主动脉内球囊反搏辅助145例,术中转为体外循环下辅助手术35例。术后呼吸机辅助呼吸时间(12.8±4.5)h,术后监护室停留时间(16.2±5.0)h。术后出现并发症50例,发生率4.35%,包括心肌梗死2例,出血25例,脑卒中14例,纵隔感染11例,肾衰竭18例,其他12例。平均随访(48.9±16.3)个月,心脏功能不同程度得到改善,生活质量提高。结论不停跳冠脉搭桥术是一种较为安全的冠心病治疗方法,术中使用分流栓和瞬时血流量测定是保障桥血管通畅的重要手段,围术期维持循环稳定是减少并发症的重要环节。

Objective To analyze early clinical results of 1150 consecutive patients undergoing off pump coronary artery bypass grafting （OPCABG） procedure, and share our experiences. Methods 1150 consecutive patients who underwent OPCABG through sternotomy between January 2001 and December 2011 were studied. Data were collected regarding the preoperative, intraoperative, and postoperative of all patients. Results The average number of distal anastomoses per patient was 3.25±0.30. The average operation time was 329.2±53.5 （235-580）min. Thirty-day mortality rate was 1.13%. One hundred forty-five patients received preoperative intra-aortic balloon pump support therapy. Thirty-five patients were divided into on-pump for hemodynamic deterioration. The rate of postoperative complications was 4.35% , including myocardial infraction（2）, bleeding（25）, stroke（14）, mediastinitis（11）, new-onset renal failure（18）, and others（12）. Meanfollow-up time was 48.9±16.3 months （range： 3 month to 130 months）. There was a marked improvement in patients’ quality of life at follow-up. Angina disappeared in all patients after surgery, and heart function improved to grade Ⅰ-Ⅱ. No perioeprative infraction occurred. Conclusion OPCABG techniques are safe and feasible for coronary revascularization in patients with coronary artery disease. Intraoperative transit-time flow measurements, intraluminal coronary shunt, and hemodynamic stability are key points for successful OPCABG procedures.