分期杂交技术治疗冠心病多支血管病变

Staged hybrid coronary revascularization for treatment of multi-vessel coronary artery disease

目的 分期杂交技术是治疗冠心病多支血管病变的新式治疗方法,总结分期杂交技术治疗多支冠脉病变的临床效果.方法 2014年8月至2016年3月,80例多支冠状动脉血管病变的冠心病患者于我科接受经皮冠状动脉介入治疗与微创小切口直视不停跳冠状动脉搭桥手术结合的分期杂交治疗.我们对患者围手术期资料和治疗结果进行分析,总结分期杂交技术的治疗效果.结果 80例患者均顺利接受分期杂交治疗,平均植入冠状动脉内支架1.5个/人.10例患者为先接受冠状动脉介入治疗,其余患者先接受微创直视搭桥手术.无患者手术中转为开胸手术.术后呼吸机使用时间（7.3±3.1）h,监护室停留时间（20.1±10.4）h.75例患者未输血,占93.8%（75/80）.造影提示左乳内动脉至前降支血管桥通畅.1例患者发生围手术期下壁心肌梗死,在闭塞右冠状动脉植入支架后恢复出院.住院期间无死亡、脑卒中等情况发生.随访期间效果良好.结论 分期杂交技术是治疗多支冠状动脉狭窄安全、有效的方法,治疗策略需要心外科医师与介入医师共同决定.围手术期抗凝药物的使用与分期治疗顺序相关.

Objective This study was to investigate effect of staged hybrid revascularization as new treat-ment for multi-vessel coronary artery disease. Methods From Aug 2014 to Mar 2016,80 patients with multi-vessel coronary artery disease underwent staged hybrid coronary revascularization,which combined of minimally in-vasive direct coronary artery bypass and percutaneous coronary intervention. Perioperative data and clinic result were collected and analyzed. Results 80 patients underwent successful staged hybrid coronary revascularization with 1.5 stents per patient. 10 patients underwent PCI-first and 70 patients underwent MIDCAB-first hybrid pro-cedure. No conversion to sternotomy occurred during surgical procedure. Postoperative mechanical ventilation time was（7.3±3.1）h,mean intensive care unit stay time was（20.1±10.4）h. 75 patients（75/80,93.8%）didn′t have transfusion of blood product. Postoperative angiography showed patent LIMA to LAD graft in all patients. 1 patient developed postoperative inferior wall myocardium infarction,which was due to acute occlusion of critically stenosis in right coronary artery. He recovered well after re-open right coronary artery with percutaneous coronary stent. No death or stroke occur during hospitalization and follow up. Conclusion Staged HCR technique is a safe and effec-tive treatment for multi-vessel coronary artery disease. Surgeons and interventionists discuss together preoperatively and make strategy for staged HCR. Perioperative anticoagulation regimen is adjusted according to sequence of staged revascularization.