摘要
目的总结非体外循环冠状动脉搭桥术(OPCAB)的近期疗效,探讨该术式的临床实用价值。方法回顾分析我院收治的274例冠心病并行非体外循环冠脉搭桥手术患者的临床资料,其中单支血管病变19例,双支血管病变54例,三支血管病变201例,左主干病变的36例。结果全组患者接受非体外循环心脏不停跳冠状动脉搭桥术,平均搭桥3.14根,全组中转为体外循环辅助冠脉搭桥手术1例(0.36%),术前放置IABP辅助4例(1.46%)患者,术后顺利停用IABP。离开手术室无需用正性肌力药物196例(71.5%),须用多巴胺泵入维持血压78例(28.5%)。术后4～108h,平均(8±5.5)h拔除气管插管。胸腔引流量280～1200ml,平均(415±260)ml;输血0～1600ml,平均(260±107)ml;住ICU时间0.7～50d,平均(1.8±0.8)d;术后8～50d,平均(14.8±5.5)d出院。无手术中死亡。术后围手术期死亡11例(4.01%)。出现轻度精神症状57例(20.8%),全组无脑中风,感染59例(21.5%),出现心房纤颤77例(28.10%)。术后随访0～96个月,平均(35±7)个月,所有患者心绞痛症状消失,活动量增加,随访超过6个月的236例患者中223例(94.5%)无需服用硝酸甘油类药物,13例(5.5%)需少量口服硝酸甘油类药。结论非体外循环冠状动脉搭桥术安全、有效,更适用于体外循环高危患者,并可应用于多支血管病变,值得临床推广应用。
Objective To analyze 274 patients underwent off-pump coronary artery bypass grafting surgery （OP- CAB）in order to summarize surgical techniques and clinical outcome. Methods 274 patients underwent off-pump CABG （OPCAB） were collected and retrospectively analyzed. 196 patients were male and 78 patients were female. Age range was 45-80（average 70.5±5.7）. 19 patients had single vessel disease. 54 patients had twi-vessels disease. 201 patients had triple vessels disease. 36 patients had left main stem stenosos. Results All of the 274 patients underwent off-pump CABG （OPCAB）. The average graft was 3.14 per case. One patient （0. 360/{） with left main stem stenosis was trans- ferred to on-pump CABG. IABP was used in 4 （1.46%） patients preoperative. There were 196 patients （71.50//oo） left operation room without using dopamine, only 78 patients （28.5%） left with using it. The respirator was used 4-108 hours（average time 8±5.5）. The average chest drainage and blood transfusion were （415±260）ml and （260± 107） ml. The average ICU and hospital stay were （1.8 ± 0.8）d and （14. 8 ± 5.5）d. The operative mortality was 11 （4.01%）. There are 57 patients had mental symptom after operation without stroke. Infection appeared in 59 patients （21.5%）. Atrial fibrillation appeared in 77 patients （28.1%）. 5 of the all survival patients had symptoms of angina during the fol- low-up（0-96 months）. There were 223 （94.5%）of 236 patients over 6 months follow-up without using nitroglycerin. On- ly 13（5.5 %） needed it. Conclusion OPCABG is safe, cost-effective, and suitable for patients with high risk of extraeor- poreal circulation,
出处
《西部医学》
2012年第11期2122-2125,共4页
Medical Journal of West China
基金
四川省卫生厅科研项目(编号:090121)
关键词
冠状动脉搭桥术
非体外循环
近期疗效
Coronary artery bypass grafting
off-pump
Late therapeutic effect
