正-逆灌并选择性桥血管灌注技术在重症冠状动脉旁路移植术中的价值

Value of anterograde-retrograde and selective bypass graft vessel perfusion technology in severe coronary artery bypass graft surgery

目的总结和分析顺-逆灌并选择性桥血管灌注技术在重症冠状动脉旁路移植术(coronary artery bypass grafting,CABG)中的应用价值。方法回顾分析2010年6月至2011年12月河南省人民医院收治的重症冠状动脉粥样硬化性心脏病(冠心病)患者152例的临床资料。术前患者均常规行冠状动脉造影术,其中合并左主干病变46例,狭窄程度均大于70%,左前降支完全闭塞51例,前降支及右冠状动脉均完全闭塞29例,三支血管弥漫性病变并血管细小55例;所有手术均在体外循环下进行,术中均经冠状动脉顺灌加冠状静脉窦逆灌并选择性桥血管灌注进行心肌保护。结果所有患者术中转流平稳,150例自动复跳,2例出现心室颤动,电除颤后顺利复跳,均顺利停机。术后5例出现低心排血量综合征,1例肾功能不全,2例低氧血症,经调整后均恢复,无死亡患者。结论在重症CABG中,采用顺-逆灌并选择性桥血管灌注技术具有良好的心肌保护效果,能够明显改善患者的预后。

Objectives To summarize and analyze the value of anterograde-retrograde and selective bypass graft vessel perfusion technology in severe coronary artery bypass graft surgery （CABG）. Methods We retrospectively analyzed the clinical data of 152 cases with severe coronary atherosclerotic disease in Henan Provincial People＇s Hospital from June 2010 to December 2011. Pre-operative coronary angiography （CAG） showed： 46 cases had lesions in the left main coronary artery （ LM ）, and the degree of stenosis was greater than 70% ; the left anterior descending coronary artery （LAD） was completely occluded in 51 cases; both LAD and right coronary a^1ery （RCA） were completely occluded in 29 cases; the three-vessel coronary had diffuse lesion and severe stenosis in 55 eases. All the operations were carried out under cardiopulmonary bypass （CPB）. During operation, we took anterograde-retrograde and selective bypass graft vessel perfusion method for myocardial protection. Results All the patients remained stable during CPB; 150 patients rebeat by themselves ; 2 patients occurred ventrieular fibrillation and rebeat after electrical defibrillation. After operation, 5 patients had low cardiac output syndrome, 1 patient had renal insufficiency, 2 patients had hypoxemia, and they all recoverd after therapy. No patient died. Conclusions For severe CABG, anterograde-retmgrade and selective bypass graft vessel perfusion technology has a good myocardial protection effect, and can significantly improve the prognosis of patients.