非体外循环冠状动脉旁路移植术术式改变156例分析

The report of 156 cases of conversion from off-pump coronary artery bypass grafting to cardiopulmonary bypass grafting during surgery

目的:总结156例非体外循环冠状动脉旁路移植术(OPCAB),术中术式改为体外循环辅助下心脏跳动中冠状动脉旁路移植手术(CABG)的经验。方法:选取2006年1月至2016年1月,同一手术组实施的OPCAB术中术式改为体外循环辅助下CABG术病例156例,分析其中原因及危险因素。结果:156例患者中,左主干狭窄>50%以上49例,术前左心室射血分数<40%105例,手术方式改变原因依次为:低心排出量综合征、恶性心律失常难以控制、以及目标血管无法暴露充分。结论:CABG术中对于部分左主干狭窄病变,严重心功能不全、目标血管难以暴露的患者,体外循环辅助下手术是一种更为安全可靠的手术方法。

Objective： To summarize the experience of 156 cases of conversion from off-pump coronary artery bypass grafting（ OPCAB） to cardiopulmonary bypass grafting during surgery. Methods： From January2006 to January 2016,156 cases of conversion OPCAB to cardiopulmonary bypass grafting during surgery were selected and analyzed the causes and risk fact. Results： In 156 patients,left main stenosis was more than 50%in 49 cases,and left ventricular ejection fraction was lower than 40% in 105 cases. The reasons were as follows： low cardiac output syndrome,difficult to control the malignant arrhythmia,and the target vessel could not be exposed adequately. Conclusion： For some patients with left main stenosis,severe cardiac insufficiency,and target vessel is difficult to be exposed,coronary artery bypass surgery on beating heart assisted by cardiopulmonary bypass may be a more safe and reliable operation method。