高龄冠状动脉搭桥患者胸骨保护策略比较  

New strategies for sternum protection in the elderly patients undergoing coronary artery bypass grafting

作　　者：王毓琳[1] 李继军 赖颢[1] 郑佳予[1] 李军[1] 徐德民[1] 王春生[1] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032 [2]新疆喀什地区第二人民医院心胸外科

出　　处：《心血管外科杂志（电子版）》2014年第1期14-18,共5页Journal of Cardiovascular Surgery(Electronic Edition)

基　　金：上海市重点学科建设项目(B116)

摘　　要：目的总结应用"骨骼化"乳内动脉获取技术结合钛板钉胸骨固定技术对高龄冠状动脉搭桥患者胸骨保护的经验。方法回顾分析70岁以上行冠状动脉搭桥术的患者202例,按照获取乳内动脉技术的不同分为研究组(骨骼化法)和对照组(传统带蒂法)。研究组:患者34例,男27例,女7例;9例患者以SternaLock钛板钉胸骨固定系统固定胸骨,其他25例采用钢丝环扎法固定胸骨。对照组:患者168例,男125例,女43例;全部采用钢丝环扎法固定胸骨。结果研究组无住院死亡,无胸骨愈合不良及相关并发症。对照组4例病死,10例胸骨愈合不良,其中1例并发纵隔感染而死亡。具有三项或以上胸骨愈合不良危险因素的患者,研究组与对照组比较胸骨愈合不良的发生率具有统计学差异[0(0/12)vs.29.2%(7/24),P=0.04]。结论应用"骨骼化法"获取乳内动脉结合钛板钉胸骨固定系统技术,可使高龄冠状动脉搭桥患者受益。Objective To describe and review our experiences in a new technique of skeletonized harvesting of the left internal mammary artery ( LIMA) combined with the use of titanium plate fixation for sternal closure in elderly patients undergoing coronary artery bypass grafting (CABG).Methods 202 elderly patients(age>70 years) undergoing CABG during January 2011 to June 2012 were divided into study group and control group retrospectively.Study group:Skeletonized LIMAs were harvested in all 34 cases,in which 27 patients were males and 7 patients were females .SternaLock titanium plate fixation was used to fix sternum in 9 high-risk patients . Control group:Traditional pedicled LIMA combined with cerclage fixation of the sternum was applied in 168 cases, in which 125 patients were males and 43 patients were females .Results In study group no patient died or complicated with sternal dehiscence .In control group,four patients died,in which one patient died of mediastinitis and three died of multiple organ dysfunction syndrome ( MODS) .Ten cases complicated with sternal dehiscence .The sternal complication rate of high-risk patients between these two groups had significant difference [ 0 ( 0/12 ) vs. 29.2%(7/24),P =0.04].Conclusion The technique of skeletonized harvesting of LIMA and titanium plate fixation for sternal closure benefits the elderly patients undergoing CABG .

关 键 词：冠状动脉旁路移植术 非体外循环 胸骨 骨骼化乳内动脉 钛板钉固定系统 

分 类 号：R654.2[医药卫生—外科学]