连续375例不停跳冠脉搭桥手术无早期死亡临床经验  

No mortality clinical experiences in consecutive 375 patients undergoing off pump coronary artery bypass graft surgery

作　　者：杨传瑞[1] 李大连[2] 郭建中[2] 程智广[2] 白涛[1] 黄信生[1] 乔志钰[1] 李莹莹[2] 崔永超[2] 杨峰[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029 [2]首都医科大学附属北京友谊医院心脏中心心脏外科

出　　处：《北京医学》2013年第7期495-498,共4页Beijing Medical Journal

摘　　要：目的总结连续375例不停跳冠状动脉搭桥手术无住院死亡的临床经验。方法回顾性分析连续375例择期不停跳冠脉搭桥手术患者临床资料。结果本组中男244例,女131例,平均年龄(64.2±13.6)岁,术前预防性使用主动脉内球囊反搏辅助25例。术中平均搭桥(3.45±0.36)支,平均手术时间(329.2±53.9)min,乳内动脉使用率为95.2%,桡动脉使用率为46.7%,术中紧急转为体外循环下手术9例。6例发生围术期心肌梗死。术后呼吸机辅助呼吸时间为(11.5±3.8)h,监护室停留时间为(14.6±5.7)h,无住院手术死亡(手术后30d内)。术后平均随访(53.5±18.9)个月,大多数患者心功能明显改善。结论严格把握不停跳冠脉手术适应征,术中正确使用分流栓,no-touch以及精细的吻合技术是手术成功的关键,并可达到完全血管化的要求。Objective To summarize the clinical experiences in 375 consecutive patients undergoing off-pump coronary artery bypass graft surgery.Methods Between June 2003 and October 2008,375 patients who were underwent isolated OPCABG were enrolled.Data were collected regarding the preoperative,intraoperative,and postoperative clinical course of all patients.Results The average number of distal anastomoses per patient was 3.45±0.36（1～5）.The average operation time was 329.2 ±53.9（235～421）minutes.Twenty-five patients were received preoperative intra-aortic balloon pump support therapy.Left internal mammary artery and left radial artery were used in 95.2% and 46.7% of the patients respectively.Nine patients were converted to on-pump for hemodynamic deterioration.Peri-operative infraction occurred in 6 cases.The mean time of postoperative mechanical assisted ventilation and intensive care unit was 11.5±3.8（3～72） hours and 14.6±5.7（6～98） hours respectively.Mean follow-up time was 53.5±18.9 months（range 32 months to 93 months）.There was no operation related death（in 30 days postoperatively）.There was a marked improvement in patients＇ quality of life at follow-up.Angina in most patients disappeared after surgery,and heart function improved to grade Ⅰ～Ⅱ.Conclusion With clinical indications,intraluminal coronary shunt,no-touch technique and refined anastomosis technique,off-pump coronary artery bypass grafting approach can offer excellent clinical outcomes and complete revascularization in coronary artery disease patients.

关 键 词：不停跳冠脉搭桥 手术 冠心病 

分 类 号：R654.2[医药卫生—外科学]