冠状动脉旁路移植术1018例临床分析  

Clinical analysis of 1018 cases of coronary artery bypass grafting

作　　者：高长青[1] 李伯君[1] 肖苍松[1] 王刚[1] 姜胜利[1] 吴扬[1] 马晓辉[1] 朱朗标[1] 刘国鹏[1] 盛炜[1] 

机构地区：[1]解放军总医院心血管外科全军心脏外科研究所,北京100853

出　　处：《中华外科杂志》2005年第14期929-932,共4页Chinese Journal of Surgery

摘　　要：目的总结、探讨冠状动脉搭桥术的外科技术及临床治疗效果。方法回顾分析1997—2004年同一术者完成的冠状动脉搭桥术1018例患者的临床资料,其中非体外循环冠状动脉旁路移植术(OPCAB)510例,体外循环下冠状动脉旁路移植术(CCABG)508例。≥60岁的患者582例(57.2%)。不稳定性心绞痛患者852例;术前同时合并其他疾病患者784例(77.0%),包括瓣膜病、高血压病、糖尿病、陈旧性心肌梗死、室壁瘤、室间隔穿孔、脑梗死、阻塞性肺疾病(COPD)、慢性肾功能不全、恶性肿瘤术后等。左主干病变156例;三支病变671例,三支病变以下347例。结果死亡4例(0.39%),总体并发症(胸骨哆开、脑梗死、纵隔炎)发生率1.6%(16/1018)。OPCAB者平均搭桥(2.5±0.4)支,CCABG者平均搭桥(3.3±0.6)支。左乳内动脉使用率93.8%(955/1018),术后早期使用主动脉内气囊反搏29例。全组随访2个月～7年,随访1002例(98.4%)。结论科学的外科策略,精湛的手术技术及麻醉、体外循环技术的改进,可使CABG术的死亡率和并发症明显下降,冠状动脉旁路移植术安全、可靠,效果满意。Objective To analyze retrospectively 1018 patients who underwent coronary artery bypass grafting surgery (CABG) in order to summarize surgical techniques and clinical outcome. Methods From 1997 through 2004, data of same surgeon for 508 patients who underwent conventional coronary artery bypass surgery on pump (CCABG) and 510 patients who underwent off-pump CABG (OPCAB) were collected and analyzed retrospectively. Eight hundred and fifty-two patients had unstable angina, 582 patients were over 60 years old (57.2%) and 784 patients had concomitant diseases including valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect, stroke, chronic obstructive pulmonary diseases , renal failure and cancer. A hundred and fifty-six patients had left main stem (LIMS) stenosos and 671 patients, triple-vessel disease. Results Total mortality was 0.39% (4-case death) and morbidity, 1.6% (sternal dehiscence, stroke and mediastinitis ). The grafts per patient with CCABG and OPCAB were 3.3±0.6 vs. 2.5±0.4. Left internal mammary artery use was 93.8% of the patients, 29 patients were implanted intra-aortic ballon pump interoperatively. Follow-up was 4 months to 7 years. Conclusions Scientific surgical strategies, excellent surgical techniques and improvement of cardiac anesthesis and cardiopulmonary bypass make the mortality and morbidity decrease significantly, CABG surgery is safe and effective in patients with coronary artery disease.

关 键 词：非体外循环冠状动脉旁路移植术 临床分析 冠状动脉搭桥术 不稳定性心绞痛患者 主动脉内气囊反搏 陈旧性心肌梗死 临床治疗效果 阻塞性肺疾病 体外循环技术 三支病变 2004年 室间隔穿孔 肾功能不全 左主干病变 OPCAB CCABG 

分 类 号：R654.3[医药卫生—外科学]