非体外循环心脏不停跳冠状动脉旁路移植术102例无手术死亡临床报告

Coronary artery bypass grafting of beating heart without extra-corporeal circulation

目的 :报告 2 0 0 0年 5月至 2 0 0 2年 6月非体外循环心脏不停跳冠状动脉旁路移植术 (OPCAB) 10 2例无手术死亡的临床经验。 方法 :对 10 2例冠心病患者施行 OPCAB,占同期冠状动脉旁路移植术 (CABG)手术的 46 %,年龄 38～ 81岁 ,平均6 3.7岁。有心肌梗死史 41例 ,糖尿病史 2 9例 ,肾功能不全史 12例 ,脑卒中史 12例 ,慢性肺疾患 11例。既往曾行冠脉内支架术 2 1例。左室射血分数≤ 45 %者 2 1例。平均每例行旁路移植 2 .7支。 结果 :全组无早、晚期死亡。无围术期心梗、呼吸衰竭和肾功能衰竭 ;早期气管插管拔除率为 94%;18%的患者未输血 ;术后心绞痛复发 2例。 结论 :OPCAB安全、有效 ,可减少相应并发症 ,避免常规 CABG新造成的心肌缺血和再灌注损伤 ;正确掌握 OPCAB的手术适应证、手术技术和围术期处理 ,是确保手术疗效的关键。

Objective: To summarize our experience on 102 cases of off-pump coronary artery bypass grafting (OPCAB) between May 2000 and June 2002. Methods: One hundred and two patients received OPCAB, accounting for 46% of total coronary artery bypass grafting (CABG) during the same period. Their ages ranged from 38 to 81 years with the mean of 63.7 years. Forty-one cases had the history of myocardial infarction (MI), 29 had diabetes, 12 renal insufficience, 12 stroke, 11 COPD. Coronary stents had been implanted in 21 cases. Left ventricular EF≤45% were in 21 cases. The average number of grafting was 2.7 per cases. Results: There were no early and late death, perioperative MI, respiratory or renal failure. Early extubation was achieved in 94% of cases, no blood transfusion in 18% of cases. The angina pectoris reoccurred in 2 cases. Conclusion: OPCAB is safe and effective,it has advantages compared with standard CABG. Optimal indications of OPCAB, surgical techniques and correct perioperative management are the key factors to assure surgical outcome.