13例直视微创冠状动脉旁路移植术的临床总结  

The clinical application of minimally invasive direct coronary artery bypass graft procedure-13cases report

作　　者：李平[1] 尤斌[1] 高峰[1] 徐屹[1] 许李力[1] 刘硕[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,北京100029

出　　处：《心肺血管病杂志》2012年第4期461-463,共3页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(编号:81000090)

摘　　要：目的:初步总结直视微创冠状动脉旁路移植术(MIDCAB)的临床体会和近期临床效果。方法:自2010年9月21日至2011年11月22日,单组完成MIDCAB 13例,其中男性9例,女性4例;平均年龄(57.4±13.6)岁,范围34～77岁;平均体质量(68.1±8.3)kg;心胸比0.49±0.04;体外循环下行冠状动脉旁路移植术(CABG)+二瓣置换术(MVR),机械瓣1例,非体外循环冠状动脉搭桥术(OP-CABG)12例。结果:本组病例围术期及出院后死亡为零;平均手术时间为(4.0±1.0)h,3～5.5 h;气管插管时间平均(12.1±4.8)h,3.5～19 h;ICU时间平均(15.7±3.5)h,7～20 h;术后第一天引流量平均(378.5±187.8)mL,未输血患者:13例(100%);术后住院时间平均(6.7±2.0)d,5～10 d;切口长度平均(7.5±1.4)cm,6～10.0 cm;出院时心功能1级3例、2级10例。结论:直视微创冠状动脉旁路移植术近期手术效果良好,安全性高;具有创伤小、切口美观、出血和输血少,无胸骨感染、并发症和病死率低等优点。Objective：The aim of this study was to summarize primarily the clinical experience and the short-term clinical effect of the minimal invasive direct coronary artery bypass graft （ MIDCAB ） procedure. Methods ：From September 13, 2010 to November 22, 2011, 13 operations had been performed in our centre using MIDCAB, Among of which 9males and 4 females; mean age （57. 4±13.6）years old; mean weight（68.1±8. 3 ） kg. These operations included 1 MVR ＋ CABG operation （ replacement with mechanical valve ） with closed type extraeorporeal circulation and 12 off-pump MIDCAB operations. Results：Hospital mortality was 0; median operation time was （ 4.0±1.0 ） hours ; median mechanical ventilation time was （ 12. 1±4. 8 ） hours ; median intensive care unit stay was （15.7±3.5 ）hours, median hospital stay post operative was （6. 7±2.0 ） days; Median draining volume was （378. 5±187. 8 ）mL in the first day after operation, No transfusion occurred in all patients; Median incision length was （7. 5±1.4）cm. When leaving hospital, 3 being of heart functional class I ,10 of class II. Conclusion：MIDCAB was associated with good operative effect in the near future and superior safety; Furthermore MIDCAB has minimally invasive, good eosmesis, less postoperative bleeding, fe- wer blood transfusion, as well as the absence of sternal wound infection. It may be safely performed on selected patients with low oostolaerative mortality and morbidity.

关 键 词：直视微创冠状动脉旁路移植术 冠心病 心脏外科手术 临床效果 

分 类 号：R54[医药卫生—心血管疾病]