冠状动脉旁路移植术的早期临床分析(附1507例报告)

The early outcomes and clinical experience in coronary artery bypass grafting(report of 1 507 cases)

目的 总结 15 0 7例冠状动脉旁路移植术 (CABG)的早期临床结果和经验。方法 回顾性总结在国内 15个中心完成的 15 0 7例冠状动脉旁路移植术的临床资料 ,其中体外循环下手术 30 9例 ,非体外循环冠状动脉旁路移植术 (OPCAB) 1198例 (79.5 % )。二次旁路移植术 18例 (1.2 % )。急诊手术 14 4例 (9.5 % )。合并瓣膜替换或成形术 18例、室间隔穿孔手术 5例、室壁瘤切除术 39例、其他手术 5例。 1.7%的OPCAB手术需转为体外循环下完成。合并激光心肌血运重建术 2 6 4例 (17.5 % )。使用主动脉内球囊反搏 83例 (5 .5 % )。结果 住院死亡32例 ,总死亡率为 2 .1% ,其中OPCAB手术死亡 14例 (1.2 % )。其他并发症包括 :围术期心肌梗死 (0 .5 % )、急性左心衰竭 (0 .3% )、严重心律失常 (1.2 % )、呼吸系统并发症 (2 .1% )、器质性神经系统并发症 (1.5 % )、新发或加重的肾功能不全 (1.1% )、出血二次开胸 (1.0 % )、胸骨愈合不良 (0 .6 % )。结论 不同方式下的冠状动脉旁路移植术均安全可靠 。

Objective To summarize and analyze the early outcomes and clinical experience in 1 507 patients undergone coronary artery bypass grafting(CABG) surgery.Methods This multi center report covers 15 different institutes in China.In these 1507 cases,79.5% were off pump coronary artery bypass(OPCAB), 1.2 % were redo bypass surgery,9.5% were urgent or emergent procedures.Concurrent procedures included 18 valve surgery,5 repair of ventricular septal rupture,39 resection of left ventricular aneurysm and 264 transmyocardial laser revascularization.1.7% OPCAB were converted to cardiopulmonary bypass.Results The total hospital mortality was 2.1 % and the mortality in OPCAB was 1.2 %.The morbidity included 0.5% peri operative myocardial infarction,0.3% heart failure, 1.2 % fatal arrhythmia, 2.1 % pulmonary complication,1.5% neurotic disorder,1.1% renal dysfunction, 1.0% reopen for bleeding,0.6% delayed wound cure.Conclusions CABG surgery is a safe and feasible procedure with good early results whether the pump was used or not, though OPCAB requires certain special skills and methods in practice.