冠心病外科治疗101例

Surgical treatment of coronary artery disease in 101 patients

目的 提高冠心病外科治疗的效果。方法 1997年 7月～ 1998年 8月对 10 1例冠心病患者进行外科治疗 ,其中冠状动脉旁路移植术 (CABG) 82例 ,CABG加激光心肌血运重建术 (TMLR) 12例 ,单纯TMLR7例。左主干病变 2 1例 ,三支病变 6 1例。心功能Ⅲ、Ⅳ级者占 2 9% ,左室射血分数 (EF)值 2 3%～ 78%。合并左心室壁瘤 18例 ,左室壁瘤和室间隔穿孔 1例。共搭桥 2 5 1条 ,乳内动脉 38条 ,左桡动脉 12条 ,3例心脏不停跳。TMLR共打孔 2 2 2个。结果 死亡 1例 ,占 0 .99% ,术后并发房颤 8例 ,低心排血量 3例 ,肾功能衰竭 3例。平均随访时间 ( 13 .1± 6 .1)个月。心绞痛症状消失或减轻CABG组为 92 % ,TMLR组为 80 %。结论 正确掌握CABG和TMLR的手术适应症 ,合理选择冠脉搭桥材料 。

Objective To promote the efficacy of surgical treatment of coronary artery disease (CAD). Methods 101 patients (mean age 61.14±9.56) with CAD underwent surgical procedures including coronary artery bypass graft (CABG) in 82, transmyocardial laser revascularization (TMLR) in 7, CABG plus TMLR in 12. The lesions involved were: left main trunk in 21, all three branches in 61. Heart function in 29% patients were graded as ⅢⅣ (NYHA). The ejection fraction (EF) of left ventricle (LV) ranged from 23% to 78%. CAD plus left ventricular aneurysm in 18, left ventricular aneurysm plus perforation of ventricular septum in 1. A total of, 251 coronary artery bypass were performed (mean 2.69±0.84), using 38 internal mammary arteries, 12 left radial arteries. 3 CABG without cardiac arrest.Results All patients survived except one, the mortality rate was 0.99%. Postoperatively, there were 8 atria fibrillation, 3 low output syndrome and 3 renal failure. The mean followup period was 13.1±6 months. The rate of disappearance or alleviation of angina pectoris in CABG group was 92% and in TMLR group it was 80%.Conclusion Correct handling of indications for CABG and TMLR surgery, rational selection of bypass surgery materials and appropriate management of complications during perioperative period were important measures leading to successful treatment of CAD. (Shanghai Med J, 2000,23∶401403)