急诊冠状动脉旁路移植术

Emergent and urgent coronary artery bypass grafting

目的 分析 81例急诊冠状动脉旁路移植术的临床特点与技术方法。方法 选择 2 0 0 0年 3月至2 0 0 2年 4月行急诊单纯冠状动脉旁路移植术者 81例 ,其中有介入治疗史者 1 9例 ,不稳定心绞痛 6 8例 ,左主干病变 4 8例。左心室射血分数 (5 3.2± 1 5 .8) % ,合并心源性休克 9例。所有病例分为急性心肌梗死组 (AMI组 )和非急性心肌梗死组 (non AMI组 )。AMI组有介入治疗史者的比例和NYHA分级达到III级以上者的比例明显高于non AMI组 ,而射血分数平均值低于non AMI组 (P <0 .0 5 )。结果 非体外循环冠状动脉旁路移植术 6 9例 ,体外循环心脏跳动下手术 8例 ,体外循环低温室颤下手术 4例。AMI组使用体外循环的比例和主动脉内球囊反搏的比例明显多于non AMI组 (P <0 .0 5 ) ,而使用动脉桥的比例少于non AMI组 (P <0 .0 5 )。AMI组住院死亡率达1 9.2 % ,明显高于non AMI组的 3.6 % (P <0 .0 5 )。结论 急诊冠状动脉旁路移植术风险较大 ,技术水平要求高 。

Objective To analysis the clinical characteristic and surgical skills in emergent and urgent coronary artery bypass grafting (CABG).Methods 81 cases of emergent and urgent coronary artery bypass surgery were performed from March of 2000 to April of 2002,which was 15.5% of total CABG.19 patients had a history of interventional therapy.There were 68 patients with unstable angina and 48 with left main disease.The left ventricular ejection fraction (LVEF) was (53.2±15.8)%. 9 patients developed cardiogenic shock due to severe MI or PTCA failure.All the cases were divided into two groups:Group AMI (n=26) and Group non AMI (n=55).The percentage of patients who had intervention history and whose heart function were worse than NYHA Class Ⅲ in Group AMI were both larger than that in Group non AMI,however the mean LVEF in Group AMI was lower than that in Group non AMI ( P <0.05).Results 69 cases of revascularization were off pump coronary artery bypass (OPCAB),8 were beating heart with cardiopulmonary bypass (CPB) and 4 were hypothermic ventricular fibrillation with CPB.The CPB and IABP was used more frequently in Group AMI than in Group non AMI ( P <0.05),however the arterial grafts were less used in Group AMI( P <0.05). The hospital mortality of Group AMI was 19.2% comparing with the 3.6% in Group non AMI ( P <0.05).Conclusions Emergent and urgent CABG has higher risk and more requirements for surgical skills.A higher mortality is significantly related to the presence of AMI.