723例冠状动脉移植术体外循环临床研究

RETROSPECTIVE STUDY OF CARDIOPULMONARY BYPASS IN CORONARY ARTERY BYPASS GRAFTING

对 1 985年 4月～ 2 0 0 2年 1 1月 72 3例冠状动脉移植术 (CABG)体外循环 (CPB)及非体外循环(OP)情况进行回顾性研究。将患者按年度阶段和CABG的手术方式分为 4组。组 1 (n =6 3,1 985～ 1 996 )、组 2 (n =1 6 0 ,1 997～ 1 999)、组 3(n =2 0 9,2 0 0 0～ 2 0 0 2 )为在CPB下行CABG ;组 4 (n =2 91 ,2 0 0 0～2 0 0 2 )为在OP下行的CABG。比较各组患者在体外循环时间、阻断时间、温度、稀释度、术后的呼吸机使用时间和住ICU天数等方面的差异。年龄组 3、4大于组 1 (P <0 0 1 ) ,术前B超EF值组 3较组 2低 (P <0 0 1 )。从组 1至组 4 ,体外循环时间和阻断时间明显缩短 ,转流中的温度升高 ,稀释度降低 ,术后气管插管时间和ICU时间明显缩短 ,各组间差异有显著性意义 (P <0 0 1 )。组 1死亡 1 2例 (2 0 % ) ,组 2和组 4各死亡 1例 (0 .4 9% ,0 .34% )。说明采取简化操作 ,密切配合 ,不降温和降低稀释度等措施 ,缩短了CPB和阻断时间 ,有利于灌注管理和病人恢复 。

cases of coronary artery bypass grafting (CABG) were analyzed retrospectively. They were divided into four groups. In group 1 ( n =63,1985～1996), group 2 ( n =160, 1997～1999), and group 3 ( n =209, 2000～2002), CABG was performed with cardiopulmonary bypass (CPB). In group 4 ( n =291, 2000～2002) CABG was performed with off pump (OP). The durations of CPB and aortic cross clamp (ACC), temperature, hemodilusion, duration of using ventilator postoperatively, and ICU stay days were analyzed and compared. The patients in the groups 3 and 4 were older than those of the group 1, but younger than group 2. Pre operative supersonic EF value was lower in patients in the group 3 compared with group 2. A tendency of shortening of CPB time and ACC time, raising of temperature, lowering of hemodilusion, and shortening of ventilator time and ICU stay days could be discerned from group 1 down to group 4 ( P <0.01). In group 1 twelve patients (20%) died, in group 2 one patient (0 49%) died, and in group 4 one patient (0 34%) died. The results showed that by simplifying the operative proceduce, with better cooperation, avoid lowering of temperature and hemodilusion, shortening CPB and ACC time, the clinical results were improved.