应用左乳内动脉加桡动脉行全动脉心肌再血管化

Integrate Use of Radial Artery and Left Internal Mammary Artery to Reach Whole Arterial Myocardial Revascularization,

目的:介绍应用左乳内动脉加桡动脉行全动脉化旁路移植的初步临床经验。临床资料:本组30例病人中男25例,女5例,年龄58±8岁,术前心绞痛分级(CCS)Ⅱ级10例,Ⅲ级14例,Ⅳ级6例。有心肌梗死病史者4例,曾行PTCA者4例。术前冠状动脉造影显示单支病变5例;双支病变15例;三支病变10例;合并左主干病变2例。方法:23例在微温(32～34℃)体外循环(CPB)下手术,应用4:1温血停跳液保护心肌。7例在非体外循环心脏不停跳下手术,均把左乳内动脉(LIMA)吻合至左前降支,其它支均应用桡动脉(RA)做吻合。术中常规应用静脉硝酸甘油防止冠状动脉及乳内动脉痉挛,地尔硫(艹卓)0.5～1.0μg·kg^(-1)·h^(-1)防止RA痉挛。转出ICU前改口服硝酸酯制剂及钙拮抗剂至术后半年。结果:全组病人共移植血管67根,其中LIMA桥30根,RA桥37根。23例应用CPB者体外循环时间(89±26)min,主动脉阻断时间(52±1)min。全组无手术死亡,无围手术期心肌梗死,术后并发症右下叶肺不张1例,切口感染1例,余病人均顺利恢复。结论:应用左乳内动脉加桡动脉所达到的全动脉化冠状动脉旁路移植术,其术后近期结果满意。

Objective: To present the initial clinical eKperience of integrate of radial artery (RA) and left internal mammary artery(LIMA) for whole arterial myoeardial revascularization. Clinical Data: Of 30 patients, there were 25 male, and 5 female. The mean age was 58±8 years. The angina CCS class status was Ⅱ in 10 patients, 14 in Ⅲ, and 6 in IV, respecⅣ tively. Angiography showed single vessel diseases in 5, double in 15, and triple in 10 , and left main disease in 2 patients, respectively. Method: 23 patients underwent CABC with standard cardiopulmonary bypass(CPB), and 7 patients with off-pump technique. The grafts composite were LIMA to left anterior descending (LAD), and RA to the other branches. Intravenous nitroglycerin and diltiazem where used to prevent spasm before the patients transferred out of the ICU, and then oral agents was used for at least 6 months postoperatively. Results: there was no death in this group. Total grafts were 67, of them; LIMA where 30, and RA 37, respectively. The CPB time was (89±26) min. Aortic cross clamping time was (52±19) min. There was no major postoperative complication occurred in all patients. Conclusion: Integrated use of RA and LIMA for whole arterial myocardial revascularization was practically. The early result was satisfactory.