142例体外循环下冠状动脉旁路移植术临床分析

Clinical Analysis of 142 Cases of Coronary Artery Bypass Grafting under Extracorporeal Circulation

目的：总结冠状动脉旁路移植术（CABG）的临床经验及疗效．方法回顾性分析2012年1月至2013年7月昆明医科大学附属延安医院心脏大血管外科142例患者行CABG的临床资料，男92例，女50例，年龄24-78岁，平均（59.5±5.8）岁．手术方法采用左侧胸廓内动脉-左前降支、右冠状动脉及回旋支动脉使用大隐静脉吻合，同期处理瓣膜变及室壁瘤，平均搭桥3.89支/人．结果手术死亡2例，死亡率1.41%．术后总并发症（包括心律失常、低心排、肾功能不全、呼吸衰竭、脑梗/脑出血、再次开胸止血、切口愈合不良）发生率为11.2%，住院人均总费用（6.89±2.34）万元，术后随访时间（8.9±2.1）月，随访率达96%，术后患者均复查超声心动图，提示左室舒张末直径及左室射血分数均有不同程度的改善．结论应用多支桥血管移植的方法，手术死亡率明显降低，患者心功能改善，住院费用下降.

Objective To summarize the clinical experience, operation indicators and curative effect of 142 cases of coronary artery bypass grafting （CABG） surgery. Methods We retrospectively analyzed the clinical data of 142 cases of CABG from January 2012 to July 2013 in the Department of Cardiovascular Surgery of Affiliated Yan ＆#39;an Hospital of Kunming Medical University. The patients included 92 cases of male, 50 cases of female, aged 24 to 78 years old, average （59.5±5.8） gears. Surgery was performed within the thoracic artery on the left of the left anterior descending branch and right coronary artery and convolution using great saphenous vein arterial anastomosis, treatment of valvular disease and aneurysm at same period,the average bypass 3.89/person. Results Two patients died after the operation,the motality rate was 1.41%. Postoperative complications included low cardiac arrhythmia, cardiac,renal insufficiency, respiratory failure, cerebral infarction/cerebral hemorrhage, open chest again stop bleeding,poor healing of incision, the incidence was 11.2%. The hospital total cost was （68.9±23.4） thousand yuan per patient,the postoperative follow-up time was （8.9±8.9） months,the follow-up rate was 96%,the postoperative patients were reviewed by echocardiography,suggesting left ventricular end-diastolic diameter and left ventricular ejection fraction were improved by different degrees. Conclusion Application of the mulitivessel transplantation methods can reduce the surgical mortality improve the cardiac function and decrease the hospital costs of patients.