非体外循环下冠状动脉旁路移植术疗效分析

The curative effect of coronary artery bypass grafting under non-extracorporeal circulation

目的:分析非体外循环下冠状动脉旁路移植术的临床疗效。方法:回顾性分析2013年2月至2016年10月在上海市第十人民医院心脏外科进行首次单纯非体外循环下冠状动脉旁路移植术的264例患者的临床资料,观察术中桥血管流量情况,对比术前、术后(出院前)、术后1年的超声心动图指标,并探讨左室射血分数变化与术中桥血管流量的关系。结果:术中动脉桥平均每支流量低于静脉桥平均每支流量[(36.7±23.0)m L/min对(42.9±25.2)m L/min],不同移植数量的桥血管总流量之间具有显著性差异(P均<0.01)。术后早期左房内径、左室舒张末期内径、左室收缩末期内径均较术前下降(P均<0.01);术后1年左室射血分数较术前改善(P<0.01),改善程度与术中桥血管的流量存在相关性。结论:非体外循环下冠状动脉旁路移植术中增加移植血管数量及吻合口数量可增加冠状动脉血流量,充分再血管化能够改善术后心脏收缩功能。

Objective:To summarize and analyze the clinical efficacy of coronary artery bypass grafting under non-extracorporeal circulation.Methods:Retrospectively analyze the clinical datas of patients underwent first time coronary artery bypass grafting under non-extracorporeal circulation from February 2013 to October 2016 in Shanghai Tenth Peopled Hospital.Analyze the bridge vascular blood flow conditions,and compare the change of chamber diameter of each heart cavity and left ventricular ejection fraction before the operation,after the operation(before discharge)and one year after surgery.The relationship between the changes of left ventricular ejection fraction and the bridge vascular blood flow were explored.Results:The average arterial bridge vascular flow was lower than the average venous bridge blood flow[(36.7土23.0)ml/min to(42.9土25.2)ml/min].There was a significant difference among the total blood flow of different numbers of bridge vessels(P<0.01).In the early postoperative period,the left atrial diameter,left ventricular diastolic diameter and left ventricular systolic diameter were all lower than those before surgery(all P<0.01).There was a statistically significant improvement in left ventricular ejection fraction at the first year after surgery,which was correlated with the flow rate of intraoperative bridge vessels.Conclusions:Increasing the number of grafts and anastomosis can increase coronary blood flow in coronary artery bypass grafting under non-extracorporeal circulation.More adequate revascularization can improve cardiac systolic function after surgery.