1405例冠状动脉旁路移植、激光心肌血运重建术的临床分析  

Clinical Analysis of 1405 Patients Undergoing Coronary Artery Bypass Grafting and Transmyocardial Laser Revascularization

作　　者：肖明第[1] 肖亦敏[1] 袁忠祥[1] 卢成宝[1] 吕志前[1] 徐根兴[1] 

机构地区：[1]上海交通大学附属第一人民医院心脏外科,上海200080

出　　处：《中国胸心血管外科临床杂志》2006年第5期289-293,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的总结冠心病患者行冠状动脉旁路移植术（CABG）和激光心肌血运重建术（TMLR）中的治疗难点、围术期处理要点，以提高冠心病患者的外科治疗效果。方法1997年5月～2006年1月，1405例冠心病患者中在体外循环下行CABG 825例，其中单纯CABG 666例，CABG＋心瓣膜手术98例，CABG＋室壁瘤手术55例，CABG＋左心房粘液瘤摘除术2例，CABG＋室间隔穿孔修补术2例，CABG＋升主动脉成形术1例，CABG＋纵隔内肿瘤切除术1例；非体外循环下CABG（OPCAB）500例；单纯TMLR30例，CABG＋TMLR50例。结果每例移植旁路血管2.9±1.0支。住院死亡42例（3．0％），死亡原因包括出血、心肌梗死、低心排血量综合征、肾功能衰竭、多器官功能衰竭等。术后发生并发症70例，包括出血、低心排血量综合征、心肌梗死、肾功能不全等，均经积极的对症处理后治愈或好转。术前心绞痛（CCS）为Ⅲ～Ⅳ级的1177例患者中，术后1154例（98．0％）改善为0～Ⅰ级。术后随访857例（62．9％），随访时间8．3±2．9个月。随访6个月时788例（91．9％）无心绞痛发作，复查超声心动图提示：左心室射血分数0．66±0.10，较术前提高7．9％，生活质量较术前大为提高。结论CABG已成为治疗冠心病最有效的常规手术，只要能正确掌握适应证，有效地加强围术期管理，便可以扩大手术适应证范围，降低手术死亡率和并发症发生率，提高手术疗效。Objective To summarize the essential of perioperative therapy and improve the prognosis of coronary artery bypass grafting （CABG） and transmyocardial laser revascularization （TMLR） through analyzing 1405 patients with coronary atherosclerotic heart disease. Methods From May 1997 to January 2006, 1 405 patients were treated in our hospital. On-pump CABG were performed in 825 patients, single CABG were performed in 666 patients, CABG with cardiac valvular operation in 98 patients, CABG with cardiac ventricular aneurysm resection in 55 patients, CABG with ventricular septal defect repairment in 2 patients; CABG with left atrium gelatinous tumor resection in 2 patients, CABG with ascending aorta repairment in 1 patient, and mediastinal septum tumor resection in 1 patient. Off-pump coronary artery bypass grafting （OPCAB） were performed in 500 patients; single TMLR were performed in 30 patients, CABG＋TMLR were performed in 50 patients. Results The number of bridge vessel was 2.9±1.0. Forty-two patients（3.0%） died of bleeding, myocardial infarction, low cardiac output syndrome, renal failure, multiple organ failure（MOF） and so on. Various complications were occurred in 70 patients（5.0%）, including bleeding, low cardiac output syndrome, myocardial infarction, renal failure and so on. All of them were recovered after treatment. There were 1 177 patients of angina in grade Ⅲ-Ⅳ （CCS） before operation, 1 154 of them （98.0%） changed in grade 0-Ⅰ （CCS） postoperatively. There were 857 patients （62.9%） in follow-up for 8.3±2.9 months postoperatively. There was no angina in 788 patients（91.9%） 6 months after surgery. The ultrasonic graphic showed that left ventricular ejection fraction was 0.66±0.10 and raised 7.9% than that before operation. The quality of life was better than before. Conclusion CABG has become the most potent routine operation in the therapy of coronary artery disease. It can extend the applications of CABG and improve the operative prognosis, if the indica

关 键 词：冠状动脉粥样硬化性心脏病 冠状动脉旁路移植术 激光心肌血运重建术 

分 类 号：R654.2[医药卫生—外科学]