非体外循环下多支冠状动脉病变的旁路移植术

Off-pump coronary artery bypass grafting for multi-vessel coronary patients

目的:探讨非体外循环冠状动脉旁路移植术的手术技巧和术中处理方法。方法:连续57例患者接受非体外循环冠状动脉旁路移植术。术中予以适量扩容、小剂量α受体兴奋剂以维持血流动力学平稳,采用心脏稳定器控制局部心肌运动幅度,阻断冠状动脉或在置入血管塞控制冠状动脉出血情况下进行血管吻合。全组吻合前降支57例,对角支21例,右冠状动脉27例,钝缘支42例,后降支20例。结果:术后1例死于并发感染和急性肾功能衰竭,余患者痊愈出院。随访所有患者心绞痛症状均消失,冠状动脉造影示桥路和吻合口通畅。结论:选择合适的病例进行非体外循环冠状动脉旁路移植术可获得满意的临床效果。术中血流动力学稳定极为重要。弹力线阻断靶血管近远端或腔内置入血管塞法均能有效地控制切开的冠状动脉出血。冠状动脉吻合的顺序应是先行前降支和右冠系统的吻合。

Objective: To discuss the operative techniques and perioperative management of coronary artery bypass grafting (OPCABG). Methods: Consecutive 57 cases with multi-vessel coronary received OPCABG. The blood volume was controlled and low-dosage a-reception vasopressor was given to maintain stable hemodynamics during operation. All the procedures were carried out with the assistance of heart stabilizer and temporary occlusion or intraluminal shunts of target coronary arteries. The anastomosis sites included 57 at the left anterior descending artery, 21 at the diagonal branch, 27 at the right coronary artery, 42 at the obtuse marginal branch, 20 at the posterior descending artrery. Results: One patient died of infection and acute renal failure on 16th day after operative. All patients were clinically asymptomatic, and coronary angiographies showed that all grafting and anastomosic site were patent. Conclusion: OPCABG has good clinical results for appropriate coronary patients. A stable hemodynamics is the key point for smooth performance of the operation. Temporary coronary occlusion or intra-arterial shunts can provide a bloodless anastomosic site. The coronary anastomosis should start from the left anterior descending or the right coronary artery systems.