严重左主干伴三支血管高度狭窄冠心病患者的外科处理  

Surgical treatment for severe LMA stenosis with severe three-vessel-disease

作　　者：王非[1] 王凤林[1] 刘鹏[1] 林凡[1] 曹德生[1] 叶志东[1] 周明[1] 孙光[1] 

机构地区：[1]中日友好医院心脏血管外科,北京市100029

出　　处：《中国心血管病研究》2007年第11期801-804,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的回顾研究严重左主干病变(狭窄>85%)伴三支血管病变(狭窄>80%)的高度狭窄患者(相当于双重左主干狭窄)在体外循环下搭桥和非体外循环下搭桥的安全性和优缺点。方法回顾比较2002年1月至2005年12月,25例患者在体外循环下(组1)和主动脉内囊反搏器(IABP)支持在非体外循环下(组2)行冠状动脉搭桥的结果。结果组1有13例,组2有12例,除相当于双重左主干病变外,根据EuroScore分级均属高危患者(EuroScore>6)。每组各死亡1例。组1和组2人均搭桥分别为(4.4±1.3)支和(3.1±1.1)支(P<0.05)。组2无1例转成体外循环下手术。结论对于相当于双左主干严重冠心病患者的高危病例,在体外循环下或在预先置入IABP的辅助下行非体外循环下手术是安全的。Objective To retrospective study the safety and advantage and disadvantage of the patients with severe left main artery stenosis （〉85%） with three-vessel-disease （〉80%） undergone either by on-pump or off-pump CABG. Methods To compare the results of 25 patients, from Jan.2002 to Dec.2005, operated by onpump CABG 13 patients as group one and by off-pump, 12 patients as group two with preoperative insertion of IABP. LIMA, LRA and SVG were as grafts. The indications for preoperative insertion of IABP was severe left main artery stenosis with three-vessel-disease with severe unstable angina and/or acute myocardial infarction. Results Postoperatively there was 1 patient died in each group. There were grafts per patient （4.4±1.3） vs （3.1±1.1 ）,P〈0.05. Group Ⅰhad more frequency of complications than Group Ⅱ had. No one needs conversion from OPCABG to ONCAB and there was no any IABP related complications in Group Ⅱ . Conclusion Severe left main artery stenosis with severe three vessel disease can be operated safely by either on-pump without IABP or off-pump with preoperative insertion of IABP, which can certainly avoid the potential complications of CPB and avoid high risk of emergency conversion from no-pump to of-pump for the high risk patients.

关 键 词：冠状动脉分流术 冠状动脉狭窄 心脏外科手术 主动脉内囊反搏器 

分 类 号：R654.2[医药卫生—外科学]