冠状动脉旁路移植术62例

Coronary artery bypass graft: 62 cases report

目的 对冠状动脉旁路移植术 ( CABG)进行临床研究 ,总结冠状动脉疾病术前评估、手术治疗、及术后处理的经验 .方法 1998- 10 / 1999- 0 9行冠状动脉旁路移植术 6 2例 ,其中包括 3例风湿性心脏病患者同时行二尖瓣替换术和 2例夹层动脉瘤患者同时行主动脉根部及主动脉瓣替换术 .结果 随访 1～ 11mo,手术死亡 4例 ,术后消化道大出血 3例 ,其余患者无严重并发症 .结论 术前心功能严重受损的冠状动脉疾病患者经药物调整后可接受 CABG手术 ,正确和及时使用主动脉内球囊反搏 ( IABP)治疗可辅助此类患者度过围术期 .对于缺血性二尖瓣返流的患者 ,轻度返流术中不需特殊处理 ,中度返流需行二尖瓣成形术 ( MVP)或二尖瓣替换术 ( MVR) ,对于重度返流的患者提倡行 MVR.风湿性心脏病和大血管疾病合并冠状动脉疾病的患者同时行

AIM To investigate coronary artery bypass graft operations and summarize the experience of preoperative evaluation, operative technique and postoperative management in the treatment of coronary artery disease. METHODS From October 1998 to September 1999, 62 CABG operations were performed, with 3 cases of rheumatic heart disease complicated with mitral valve replacement and 2 cases of aortic dissection accompanied with aortic root replacement. RESULTS The operative mortality rate was 6.45% (4 patients). Three cases suffered from massive bleeding in upper digestive tract postoperatively. With 1 to 11 months' followup, no other critical complication was found after operation in this group. CONCLUSION The CABG operation can be successfully performed upon the patients with coronary artery disease with severely damaged cardiac function under the condition that he has properly been treated with medicine, and intraaortic balloon pump (IABP) treatment can help this kind of patients through perioperative period. For the patients with mild ischemic mitral regurgitation, no management for regurgitation is needed during CABG operation. For moderate regurgitation, a mitral valvoplasty or a mitral valve replacement might be necessary. The mitral valve replacement is recommended for the patients with severe regurgitation. Those with rheumatic heart valve disease or great artery disease complicated with coronary artery disease can be successfully treated by the addition of CABG to their primary operative treatment.