脑卒中患者的非体外循环冠状动脉旁路移植术  

Off pump coronary artery bypass procedures of patients with strokes

作　　者：李辉[1] 金新新[1] 万峰[1] 

机构地区：[1]北京大学人民医院冠心病微创外科中心,100044

出　　处：《北京医学》2004年第5期330-332,共3页Beijing Medical Journal

摘　　要：目的　探讨脑卒中患者接受非体外循环冠状动脉旁路移植术 (OPCAB)的耐受性、安全性和临床疗效。方法　选择 2 0 0 2年 112月完成的OPCAB手术患者 2 5 9例 ,其中术前合并脑卒中 35例 (A组 ) ;非脑卒中患者2 2 4例 (B组 )分析A、B两组术前合并症、心功能分级左室射血分数、病变支数、手术及预后情况。结果　所有病例均顺利完成OPCAB手术 ,A/B组比较平均远端吻合口数目 (3.0 8± 0 .6 2 )个 / (2 .9± 0 .78)个 ;移植物乳内动脉 31/198支 ,桡动脉 14 / 10 6支 ;机械通气时间 (12 .0± 8.2 )h/ (13.0± 6 .6 )h ;第 1天引流液 (5 34± 2 2 5 )ml/ (5 11± 2 11)ml;监护时间 (5 1± 2 2 )h/ (5 6± 19)h ;输血 16 / 86例。A组低心排后多脏器功能衰竭 1例死亡 ,可逆性精神症状 1例 ,无新的脑卒中发生 ,B组住院死亡 3例 ,可逆性精神症状 3例 ,发生脑梗死 2例。使用主动脉气囊反搏 (IABP)A组 5例 ,B组 5 0例。结论　OPCAB不增加脑卒中患者冠状动脉搭桥的脑部并发症和死亡率 ,其手术安全可行 ,而且近期临床疗效满意。Objective To analyze the tolerance safely and the clinical outcomes of patients with strokes who underwent OPCAB procedure.Methods From January,2002 to December,2002,259 OPCAB procedures were carried out in our department.Patients were divided into group A(n=35), in which 28 males and 7 females with strokes ranging from 36 to 84 years old (66±9) were taken into account,and group B(n=224) including 163 males and 61 females ranging from 46 to 82 years old (63±9),among them no cerebrovascular diseases occurred preoperatively.Further comparison between group A and group B revealed that there was no sifnificant differences in the aspects of hypertension (22/137),diabetes mellitus (12/68),hyperlipemia (5/43),myocardial infarction (14/103),class Ⅱ(10/64),class Ⅲ(20/20) and class Ⅳ(5/5),in NYHA classification,left ventricular ejection fraction (64.0±8.5/62.0±11.6),the number of patients with CAD associa with triple branches(27/190), the number of patients with left main stenosis (7/54) and the number of patients undergone emergent operations,but the class Ⅲ in NYHA classification(20/20) did appear a statistically significant difference.Results All the OPCAB procedures were completed successfully.A meticulous analysis between group A and group B was done concerning the number of distal anastomoses(3.08±0.62/2.9±0.78),the number of intramamary arteries used as grafts(31/198),radial arteries used as grafts(14/106), intubation time(12.0±8.2)h/(13.0±6.6)h,drainage in first postoperative day(534±225)ml/(511±211)ml,duration of ICU stay(51±22)h/(56±19)h,and the number of patients accepting transfusion(16/86).In group A,there was one death because of multiple organ system failure and one patient with reversible psychologic symptoms but no new strokes happened. In group B, there were three deaths, three patients with reversible psychologic symptoms and two patients with cerebral infarction.IABP was used in 5 patients in group A and in 50 patients in group B.Conclusions OPCAB procedure has no risk of incre

关 键 词：脑卒中患者 OPCAB 非体外循环冠状动脉旁路移植术 手术 术前 精神症状 并发症 脑部 数目 主动脉 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R654.2[医药卫生—临床医学]