非体外循环冠状动脉架桥手术对心脏的影响

Impact of off-pump coronary artery bypass grafting off-pump CABG on heart

目的 通过观察非体外循环下冠状动脉架桥手术时心脏的移位受压 ,分析与吻合冠状动脉相关的血液动力学改变 .方法 4 7例冠状动脉狭窄的患者 ,行非体外循环下冠状动脉架桥手术 ,采用 CTS和 octopuz两种固定器暴露吻合部位 .结果 少数患者在吻合右冠状动脉 (RCA)和对角支 (D) ;钝缘支 (OM)时需辅以去甲肾上腺素 0 .0 2～ 0 .2 0 μg·kg- 1·min- 1 以维持平均动脉压在 9.3k Pa以上 .在所有吻合区每搏量 SV和心脏指数 CI都有少许下降 ,前降支 L AD下降 1m L和 2 0 0 m L· m in- 1· m- 2 ,RCA下降 2 m L 和 2 80 m L·min- 1· m- 2 ,D下降 6 m L 和 2 2 0 m L· min- 1· m- 2 ,OM下降 1.6 m L和 2 2 0 .0 m L ,与吻合前相比无统计学差异 ,在心脏复位 15 min后 SV和 CI恢复原来水平 .结论 非体外冠脉架桥手术时 ,心脏的受压和移位可引起血液动力学的改变 。

AIM To observe heart displacement and compression during off pump CABG and to analyze the hemodynamic changes in relation to the grafted arteries. METHODS 47 patients with coronary artery stenosis underwent off pump coronary artery bypass grafting, utilizing Octo puz Tissuetabiblization system (medtronic) and CTS Stabilization(cardiothoracic) to expose the anastomosic sites. RESULTS Some of the patients were given noradrenaline 0.02~0.20 μg·kg -1 ·min -1 in order to maintain MAP above 9.3 kPa in suturing right coronary artery (RCA), diagonal branch artery (D), and obtuz marginal branch artery (OM). During the surgery on the left anterior descending artery (LAD), stroke volume (SV) and cardiac index (CI) decresed 1 mL and 200 mL·min -1 ·m -2 ; RCA, SV and CI decresed 2 mL and 280 mL; D, SV and CI decresed 6 mL and 220 mL and OM, SV and CI decresed 1.6 mL and 220.0 mL·min -1 ·m -2 ( P >0.05). All the cardiovascular indexes returned to base line values 15 min after releasing the heart. CONCLUSION This study provides evidence that the hemodynamic changes associated with heart displacement and compression during off pump CABG are of short duration and within physiological limit.