非体外循环冠状动脉旁路移植术329例疗效分析

Evaluation of off-pump coronary artery bypass in patients with myocardial infarction or angina pectoris:report of 329 cases

目的 分析 3 2 9例非体外循环冠状动脉旁路移植术 (OPCAB)的临床效果。方法2 0 0 1年 1月至 2 0 0 2年 5月完成OPCAB手术 3 2 9例 ,男 2 50例 ,女 79例 ;平均年龄 (63 6± 9 1)岁。研究对象分为三组 :陈旧性心肌梗死 95例 (2 8 9% ) ,急性心肌梗死 54例 (16 4% ) ,单纯心绞痛 180例 (54 7% )。对各组手术的近期临床效果进行统计分析。结果 全部 3 2 9例采用OPCAB手术方式 ,无一例中转至体外循环。平均旁路移植 (3 0 9± 0 77)支。旁路材料选用乳内动脉 2 66例(80 9% ) ,桡动脉 159例 (48 3 % ) ;全动脉化 2 1例 (10 1% )。术中同时行激光打孔 2 2例 (6 69% ) ;非体外循环下行室壁瘤缝缩术 1例。应用主动脉内球囊反搏 2 7例 (8 2 % )。手术死亡 4例 ,病死率1 2 %。术后严重并发症 17例 (5 2 % )。除在主动脉内球囊反搏使用方面陈旧及急性心肌梗死组明显高于心绞痛组外 ,其余各指标无组间显著性差异。

Objective To analyze the clinical results of 329 cases of off-pump coronary artery bypass (OPCAB) Methods Three hundred and twenty nine cases of OPCAB were performed from January 2001 to May 2002 The patients(250 male/79 female) ranged from 39 to 82 years old with mean age of 63 6±9 1 They were divided into three groups:95 cases with old myocardial infarction,54 acute myocardial infarction,and 180 angina pectoris The operative mortality and major complications were calculated and analyzed Results Of all 329 cases performed with OPCAB procedures,the incidence of conversion to on-pump procedures was 0% The average of distal anastomosis was 3 09±0 77 per patient(ranged from 1 to 5) Two hundred and sixty six cases(80 9%) used internal mammary arteries as grafting materials,and 159 cases(48 3%) used radial arteries The overall in-hospital mortality was 1 2%,and 17 cases (5 17%) had severe complications in this period Twenty-seven cases(8 2%) were supported with intra aortic balloon pump(IABP) during perioperative period The use of IABP in OMI and AMI groups was significantly more than angina group,while in other variables there was no difference among the three groups Conclusion OPCAB had the same safety and feasibility for patients who suffered from either myocardial infarction or angina pectoris