摘要
目的总结 2 1例重症冠心病非体外循环冠状动脉搭桥手术的临床体会。方法先行乳内动脉与前降支的吻合 ,或在主动脉内球囊反搏支持下完成手术。结果平均手术时间 2 16(196～ 2 86)分钟。 3例搭桥 3根 ,15例搭桥 4根 ,3例搭桥 5根 (4根 /人 )。平均术后呼吸机辅助时间 6(3～ 8)小时。术后应用多巴胺和多巴酚丁胺进行循环功能支持者 14例 ,应用主动脉内球囊反搏 2例 ,均于术后 48小时内撤除。术后早期发生房颤、房扑伴阵发性室上速者 12例 ,频发室性早搏者 3例 ,心包填塞二次开胸止血者 2例。结论重症冠心病非体外循环冠状动脉搭桥手术 ,应充分进行术前准备 ,制订合理的麻醉和手术方案 ,加强术中密切配合 。
Objective To sum up the clinical experiences of off pump coronary artery bypass for patients with severe coronary heart disease.Methods The anastomosis of intra mammary artery with anterior descending branch was done first or operation was performed under the support of intra aortic balloon counterpulsation (IABC).Results The average operation time was 216(196 286)minutes.3 cases were bypassed with 3 grafts,15 cases with 4 and 3 cases with 5(4/a person).The average time for respirator assisting was 6 (3～8) hours.14 cases needed Dobutamine and Dopamine to support circulation function after operation.The intra aortic balloon in 2 cases was pulled out within 8 hours after operation.Early after operation,atrial fibrillation and atrial flutter accompanied with paroxysmal supraventricular tachycardia happened in 12 cases,frequent ventricular premature beats in 3 cases and 2 cases needed second open chest to stop bleeding with cardiac tamponade.Conclusion Good preparation should be made before off pump coronary artery bypass for patients with severe coronary heart disease.Resonable anesthesia and operation protocal as well as close coorperation are of great importance to operation.Attention should be paid to postoperative management.
出处
《中国综合临床》
北大核心
2002年第9期814-815,共2页
Clinical Medicine of China
关键词
冠心病
非体外循环
冠状动脉搭桥术
Coronary heart disease
Off pump circulation
Coronary artery bypass
