急诊冠状动脉旁路移植术27例临床分析

Emergency Coronary Artery Bypass Grafting:Clinical Analysis of 27 Consecutive Patients

目的分析急诊冠状动脉旁路移植术患者的效果和治疗方法要点。方法回顾性分析2010年1月至2013年12月南京军区南京总医院160例行单纯冠状动脉旁路移植术患者的临床资料。按照手术时间将患者分为急诊手术组[确诊当日手术者,27例,男22例、女5例,年龄（70.2±10.2）岁]和择期手术组[确诊并停用抗血小板药物5 d以后手术,133例,男104例、女29例,年龄（66.3±8.9）岁],比较两组治疗效果。结果急诊手术组术前欧洲心脏手术风险评估系统（Euro SCORE评分,5.8±3.2 vs.3.4±2.1,P=0.001）、急性心肌梗死比例（33.3%vs.11.3%,P=0.007）、术后24 h平均心包和纵隔引流量[（533.4±132.8）ml vs.（414.8±124.3）ml,P=0.018]、主动脉内球囊反搏应用比例（29.6%vs.12.0%,P=0.034）均高于择期手术组,差异均有统计学意义。两组急性肾功能不全行连续性肾脏替代治疗比例（P=0.677）、术后切口并发症发生率（P=1.000）、住院时间（P=0.589）、住院死亡率（P=0.198）差异均无统计学意义。急诊手术组24例（88.89%）随访3~36个月：1例1年后再次出现心绞痛样症状,治疗症状缓解,其余患者均无心绞痛及心肌缺血表现。结论做好充分的术前评估和准备,加上术中良好的心肌保护和再血管化以及术后积极综合处理,急诊冠状动脉旁路移植术仍是救治危急重症冠心病的有效方法。

Objective To evaluate the effects of emergency coronary artery bypass grafting（ECABG） in the treatment of emergent patients,and to summarize our experience.Methods We retrospectively analyzed the clinicaldata of 160 patients who underwent coronary artery bypass grafting（CABG） in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013.The patients were divided into an ECABG group（operation underwent on the day diagnosed,n=27,22 males and 5 females,at age of 70.2±10.2 years） and a conventional group（CABG operation underwent on 5 days after diagnosed,n=133,104 males and 29 females,at age of 66.3±8.9 years）.Results Statistical differences were found between the ECABG group and the conventional group in Euro SCORE（5.8±3.2 versus 3.4±2.1,P=0.001）,acute myocardial infarction（33.3% vs.11.3%,P=0.007）,rate of application of IABP（29.6% versus 12.0%,P= 0.034）,pericardium and mediastinal tube drainage（533.4±132.8 ml versus 414.8±124.3 ml,P=0.018）.There was no statistical difference in continuous renal replacement therapy（P=0.677）,postoperative sternal wound complication（P=1.000）,the length of hospital stay（P=0.589）,or 30-day-mortality（P=0.198） between the two groups.We followed up 24 patients（88.89%） for 3-36 months in the ECABG group.One patient occurred angina symptoms at the end of 1 year follow-up.The symptoms disappeared after treatment.The other patients had no symptoms of angina pectoris and myocardial ischemia.Conclusion ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients.Sufficient preoperative assessment,good myocardial protection,full revascularization,and comprehensive treatment plays an important role in the success of ECABG.