急性心肌梗死后的冠状动脉旁路移植术

Coronary artery bypass grafting after acute myocardial infarction

目的 :总结分析 88例急性心肌梗死后 30d内进行的冠状动脉旁路移植术。方法 :88例中包括PTCA史18例 ,溶栓治疗后 12例 ,梗死后心绞痛 2 6例 ,心源性休克 9例 ,左主干病变 2 5例。其中急诊手术 2 6例。结果 :采用非体外循环法 75例 ,体外循环心脏跳动下 13例 ,平均旁路移植血管数 (3.4± 0 .9)支 ,使用主动脉内球囊反搏 14例。住院死亡 5例 ,均为心源性休克下进行的急诊手术。术后早期急性左心衰 4例 ,室上性心动过速 6例 ,频发室性早搏 6例 ,缓慢性心律失常起搏治疗 2例 ,药物治疗好转。结论 :急性心肌梗死后 30d内进行冠状动脉旁路移植术是必要而可行的 ,选用非体外循环和体外循环心脏跳动下的手术方法是安全可靠的。

Objective: To analyze 88 cases of coronary artery bypass grafting(CABG) within 30 days after acute myocardial infarction(AMI). Methods:88 cases included 18 cases with emergent angioplasty, 26 cases with postinfarctional angina pectoris, 9 cases with cardiogenic shock and 25 cases with left main lesion. Results: There were 75 cases underwent off pump coronary artery bypass(OPCAB) and 13 cases underwent beating heart CABG with cardiopulmonary bypass(BH CPB) . The mean number of bypass grafts was 3.4±0.9. Five patients with preoperative cardiogenic shock died after emergent operations. There were 4 cases with postoperative heart failure, 6 cases with PSVT and 2 cases with bradycardial and treated pacemaking. Conclusion: It was neccessory and feasible to perform CABG within 30 days after AMI. Both the OPCAB and BH CPB were safe methods.