非体外循环下冠状动脉旁路移植术460例临床分析  

Clinical analysis of off-pump coronary artery bypass in 460 cases

作　　者：孔烨[1] 杭钧彪[1] 瞿晓红[1] 朱良纲[1] 周健[1] 章剑锋[1] 

机构地区：[1]上海第二医科大学附属瑞金医院胸心外科,上海200025

出　　处：《第二军医大学学报》2005年第7期805-808,共4页Academic Journal of Second Military Medical University

摘　　要：目的:总结分析非体外循环下冠状动脉旁路移植术(OPCAB)在冠心病外科的治疗效果和临床经验。方法:1999年6月至2004年12月施行OPCAB患者,共460例,占同期单纯冠状动脉旁路手术的98.7%。其中男性356例(77.4%);年龄≥70岁的高龄病例240例(52.2%)。根据术前外科高危因素将全组分为高危病例组(265例,57.6%)和普通病例组(195例,42.4%)。全组457例经正中胸骨切口完成OPCAB,3例行胸腔镜辅助下左前外侧小切口冠状动脉旁路移植术(VATS-CAB)。21例65岁以下患者施行了全动脉化OPCAB。结果:3例(0.6%)术中转为体外循环下手术,其余457例手术均于非体外循环下完成。平均桥血管数为(2.98±1.12)支/例。手术死亡8例,总死亡率1.74%,其中普通组1.0%,高危组2.3%。83例(18.0%)术后给予正性药物支持,11例(2.4%)术后应用主动脉内囊反搏支持。460例中68.9%的病例手术当天拔除气管插管,全组平均ICU治疗时间(43.8±20.7)h。术后并发症依次为肺部感染(3.7%)、呼吸衰竭(1.1%)、肺动脉栓塞(1.1%)、胸骨感染(1.1%)、需透析治疗的肾功能衰竭(0.8%)、脑血管意外(0.6%)、二次开胸止血(0.6%)和围术期心肌梗死(0.4%)等。结论:OPCAB技术应用于冠状动脉外科临床治疗早期效果满意,且对于高危病例,其临床应用可能更具有潜在优越性。不断优化和完善OPCAB的外科技术,以及默契的麻醉配合,是保障OPCAB手术高实施率和低术式转换率的重要环节。Objective: To analyze the efficacy and clinical experience of off-pump coronary artery bypass (OPCAB) in treatment of coronary artery diseases. Methods: Between June 1999 and December 2004, 460 patients with coronary artery diseases underwent OPCAB, which accounted for 98.7% of the total 466 patients who underwent coronary bypass surgery of the same period. Of the 460 patients, 77.4% were males with a mean age of (66.7±9.5) years; 240 patients (52.2%) were ≥ 70 years, and 265 patients (57.6%) were at high surgical risk. There were 457 cases receiving OPCAB through a median sternotomic incision and the other 3 patients undergoing MIDCAB. Total arterial revascularization was performed in 21 patients whose ages were under 65 years. Results: Three cases ( 0.6%) were converted into on-pump coronary artery bypass grafting (CABG) procedure because of hemodynamic instability during operation. The average number of grafted vessels was (2.98±1.02) grafts/patient. There were 8 postoperative deaths with a 30-day hospital mortality of 1.73%. In high-risk group the mortality was 2.3%, and was 1.0% in the other patients. Eighty-three cases (18.0%) were supported by inotropics postoperatively and 11(2.4%) by IABP. About 68.9% of the patients were extubated on the same day of surgery. The average ICU stay was (43.8±20.7)h. Post-operative complications were: pulmonary infection (3.7%), respiratory failure (1.1%), pulmonary embolism (1.1%), sternal infection (1.1%),dialysis dependant renal failure (0.8%),stroke (0.6%), re-open for bleeding (0.6%), and myocardial infarction ( 0.4%). Conclusion: The outcome of OPCAB is satisfactory in 460 consecutive cases. The procedure is especially preferrable for high risk surgical patients. Improvement of OPCAB technique and appropriate anesthesia are key issues for higher OPCAB rate and lower operation transfer rate.

关 键 词：冠状动脉旁路移植 非体外循环 冠状动脉疾病 

分 类 号：R541.4[医药卫生—心血管疾病]