189例重症冠心病的冠状动脉旁路移植术临床分析

Experience of coronary artery bypass grafting for severe coronary artery disease in 189 cases

目的:提高重症冠心病人冠状动脉旁路移植术的手术疗效。方法:回顾性分析189例重症冠心病的冠状动脉旁路移植术资料。其中应用体外循环157例,非体外循环32例;搭桥数1～6(平均3.49±1.04)支/人。对手术方法、主要并发症和术后处理进行分析总结。结果:二次开胸4例(2.1％),低心排综合征9例(4.8％),应用主动脉内球囊反搏(IABP)4例(2.1％),反复发作房颤17例(9.0％),胸腔积液27例(14.3％),肺功能不全6例(3.2％),脑合并症3例(1.6％),肝功能不全5例(2.6％),肾功能不全6例(3.2％),死亡7例(3.7％),其余病人康复出院。结论:合理的选择病人,成熟的手术技术,良好的心肌保护,停机困难者IABP的尽早应用及术后处理的加强是提高重症冠心病人冠状动脉旁路移植术疗效的重要措施。

Objective: In order to improve the results of coronary artery bypass grafting (CABG) for patients with severe coronary artery disease. Methods: A retrospective study was carried out to review experience. A total of 189 cases with severe coronary artery disease underwent CABG were studied, in which 148 cases were males and 41 females. CABG with cardiopulmonary bypass (CPB) was performed in 157 patients, off-pump CABG was performed in 32 patients. We transplanted 1-6 (3.49±1. 04) blood vessels to patient. Surgical technique, complications and post-operative treatment were analyzed. Results: Early post-operative complications were included: Re-open in 4 (2. 1%) cases, low cardiac output syndrome 9 (4. 8%), repeatedly atrial fibrillation 17 (9. 0%), pleural effusion 27 (14. 3%), respiratory insufficiency 6 (3.2%), cerebral complication 3 (1. 6%), hepatic dysfunction 5 (2. 6%), renal insufficiency 3 (1. 6%) and death 7 (3. 7%); IABP was used in 4 (2. 1%) cases. The others had favorable outcomes. Conclusion; Suitable selection of patient, excellent surgical technique, advanced myocardial protection, IABP applied early when weaning from pump is difficult and enhancing post-operative treatment can significantly improve the results of CABG for the patients with severe coronary artery disease.