微创伤及常规冠状动脉搭桥术的临床实践效果分析  

Clinical efficacy of off-or on-pump coronary artery bypass

作　　者：洪丰[1] 廖志聪 张瑞祥[1] 彭建明[1] 

机构地区：[1]暨南大学附属第一医院胸心外科,广州510630 [2]澳门仁伯爵医院外科

出　　处：《广东医学》2005年第1期15-17,共3页Guangdong Medical Journal

基　　金：教育部留学回国人员科研启动基金资助项目 (编号 :教外司留1998679)

摘　　要：目的　比较分析在急性心肌梗死溶栓治疗失败后冠脉搭桥术 (微创伤OPCAB及常规CABG)与挽救性PTCA/stent的疗效 ,总结OPCAB临床实践经验。方法　将 6 6例静脉溶栓未通患者 ,分成冠脉搭桥术组 (A组 :32例 ,11例施行微创伤OPCAB ,2 1例施行常规CABG)和挽救性PTCA/stent组 (B组 :34例 ,该组所有梗死血管放置支架 ) ;两组患者于溶栓前 /溶栓时和术后 30d ,分别行 99mTc -MIBI定量门控心肌断层显像 ,测量术前、术后的两组心肌显像积分、室壁运动异常节段数、LVEF、ESV和EDV等指标 ,并计算差值。结果　术前、术后比较 :A组心肌显像积分、室壁运动异常节段数、LVEF和ESV差异有显著性 (P <0 0 5 ) ,B组只有心肌显像积分、室壁运动异常节段数差异有显著性 ;两组之间比较 :心肌显像积分、LVEF和ESV差异有显著性。结论　冠脉搭桥术是治疗急性心肌梗死溶栓未通的有效、可靠手段 ,冠脉搭桥术在心功能指标改善方面优于挽救性PTCA/stent疗法 ;微创伤OPCAB技术安全、快捷、有效。Objective To compare the efficacy of Off-or On-Pump coronary artery bypass(OPCAB or regular CABG) with that of Salvage PTCA/stent in treating AMI with non-patency on obstructed coronary arteries after intravenous thrombolytic therapy, and to evaluate the clinical efficacy of minimally invasive OPCAB. Methods 66 patients were divided into two groups. The CABG group(n=32): 11 patients underwent OPCAB and 21 patients underwent regular CABG. The Salvage PTCA/stent group(n=34): all the obstructive vessels had been placed with a stent. Both two groups underwent 99m Tc-MIBI quantitative gated myocardial perfusion SPECT(Germano method). Relative data were measured before or during the procedure of thrombolytic therapy,and 30 days after the operation. Results Within the CABG group, the following data indicated significant improvement(P<0.05) after the operation: semi-quantitative score of myocardial 99m Tc-MIBI uptake, number of the segments of regional abnormal ventricular wall, LVEF and ESV . The variations of the semi-quantitative score of myocardial 99m Tc-MIBI uptake, LVEF and ESV between the groups indicated significant difference. Conclusion Off or On-Pump CABG is reliable and effective treatment option for AMI after non-patency with intravenous thrombolytic therapy.

关 键 词：微创伤 OPCAB 心肌显像 冠脉搭桥术 室壁运动异常 LVEF 临床实践 显著性 结论 积分 

分 类 号：R654.2[医药卫生—外科学] R542.22[医药卫生—临床医学]