摘要
目的探讨不停跳冠状动脉搭桥术（off-pump coronary artery bypass,OPCAB）治疗行维持性血液透析（hemodialysis-dependent,HD）的老年冠心病的疗效与安全性。方法对5例行OPCAB术治疗的老年冠心病患者的临床资料进行回顾性分析,5例患者均合并尿毒症,行HD治疗：术前均给予常规血液透析,术后第1天均行持续床旁连续性静脉静脉血液滤过（CVVH）,术后第3天均恢复常规血液透析。结果 5例患者均手术成功,无死亡病例。手术时间为2.5-4.5h,中位时间为3.5h;术后引流量400-800mL,平均520mL;术中术后输血0-2U,平均1.2U,输血浆0-600mL,平均560mL;术后ICU住院时间2-4d,呼吸机使用时间12-20h,平均16h。术中无呼吸衰竭、低心排综合征,无消化道出血及心包填塞、二次开胸。术后随访6-24个月,所有患者胸闷、胸痛症状均有不同程度缓解,无脑神经及其他系统的并发症,无急性心梗,无血栓形成和重要脏器栓塞等严重并发症。结论对行HD治疗的老年冠心病患者给予OPCAB术是安全有效的,术后液体控制是确保其手术效果的关键。
Objective To evaluate the efficacy and safety of off-pump coronary artery bypass（OPCAB）in the treatment of coronary heart disease in hemodialysis-dependent（HD）patients.Methods Clinical data of 5elderly HD patients with uremia who underwent OPCAB were analyzed retrospectively.Conventional hemodialysis was performed before operation and on postoperative day 3.Continuous veno-venous hemofiltration was carried out on postoperative day 1.Results OPCAB was successful and no deaths occurred in all patients.The operation time,postoperative drainage volume,blood transfusion volume,plasma transfusion volume,ICU length of hospital stay and ventilator time were 2.5-4.5hours（median time 3.5hours）,400-800mL（average520mL）,0-2U（average 1.2U）,0-600mL（average 560mL）,2-4days and 12-20hours（average16hours）,respectively.No respiratory failure,low cardiac output syndrome,gastrointestinal bleeding,pericardial tamponade and reoperation occurred during OPCAB.After 6-24 months of follow-up,chest tightness and thoracodynia were alleviated and no acute myocardial infarction,thrombogenesis,embolism and other severe complications were observed in all patients.Conclusion OPCAB is safe and effective for coronary heart disease in elderly HD patients,and postoperative fluid management is critical to ensure the operative outcome.
出处
《实用临床医学（江西）》
CAS
2016年第7期42-44,共3页
Practical Clinical Medicine
