左主干病变急症冠状动脉旁路移植术指征探讨

Emergent coronary artery bypass grafting with left main coronary lesion

目的 探讨左主干病变施行急症冠状动脉旁路移植术的指征与方法。方法 总结157例左主干病变冠状动脉旁路移植术的临床特点与近期疗效,分为急症手术组(48例)和择期手术组(109例),进行对比分析。急症手术指征包括:左主干病变狭窄>90％,左主干病变在70％-90％之间合并不稳定心绞痛。急症手术组中,急性心肌梗死1周内的比例明显高于择期手术组(P<0.05)。结果 急症手术组非体外循环手术的比例达到91.7％,与择期手术组无差别;使用主动脉内球囊反搏的比例明显高于择期手术组,术后使用正性肌力药物比例明显低于择期手术组(P<0.05)。总住院死亡率为1.9％,急症手术组死亡3例(6.3％),择期手术组无死亡病例,死亡原因多与术前左心室功能低有关。随访中急症手术组院外死亡1例。结论 对于左主干病变的急症手术指征仍然存在不同理解。非体外循环冠状动脉旁路移植术在左主干病变的急症手术中是可行的。

Objective To discuss the indications and technical problems of emergent coronary artery bypass grafting (CABG) in left main(LM) coronary lesion. Methods The clinical characteristics and short-term outcome were analyzed. All cases were divided into emergent group (Group E) and selective group (Group S). The emergent CABG included the cases with more than 90% stenosis in LM and unstable angina pectoris with 70% ~90% stenosis in LM. The percentage of cases within 1 week following acute myocardial infarction was higher in Group E than that in Group S (P < 0.05). Results The percentage of off pump surgery in Group E was 91. 7% which was no significant difference between two groups. The intraaortic balloon pump was used more often in Group E than in Group S and intropic agents was administered rerioperatively less in Group E (P<0.05). The total hospital mortality was 1.9% and 6.3% in Group E which was much higher than that (0%) in Group S (P < 0. 05). The cause of death was more likely due to severe left ventricular dysfunction. There was 1 case of late death in follow-up of Group E. Conclusions The indication of emergent surgery in LM remains controversial. The off-pump surgery is feasible in most of the emergent surgery in LM lesion.