48例高危冠心病体外循环辅助下不停跳冠状动脉搭桥术的临床分析  

Experience of beating coronary artery bypass grafting assisted with extracorporeal circulation in 48 highrisk coronary patients

作　　者：蔡巍巍[1] 陈兴澎[1] 王亚宏[1] 李晓恒[1] 庞锋[1] 李宏伟[1] 李斌[1] 张小涛[1] 朱贵军[1] 

机构地区：[1]郑州大学附属洛阳中心医院心外科,河南省洛阳市471000

出　　处：《中国心血管病研究》2013年第9期657-659,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨如何提高高危冠心病患者体外循环辅助下不停跳冠状动脉旁路移植术的手术疗效。方法选择48例高危冠心病患者采用体外循环辅助下不停跳冠状动脉旁路移植术，男性32例，女性16例，对手术方法及围术期处理进行分析总结。结果共搭桥127支，平均2．63支。使用完全静脉桥22例，全动脉化10例。平均体外循环辅助时间55min。5例使用主动脉内球囊反搏（IABP）。术后早期死亡3例（6．25％），分别为低心排综合征2例、多器官功能衰竭1例。结论冠状动脉搭桥术是治疗高危冠心病的有效方法。术中尽量减少体外循环时间、合理的手术设计、术中良好的心肌保护、灵活地使用体外循环辅助、积极应用IABP是手术成功的关键。Objective In order to improve the results of beating coronary artery bypass grafting assisted with extracorporeal circulation in high-risk coronary patients. Methods A retrospective study was carried out and reviewed the experience of surgery and perioperative treatment. 48 cases with high-risk coronary artery disease underwent beating coronary artery bypass grafting assisted with extracorporeal circulation, 32 males and 16 females were enrolled. Results 127 grafts were tansplanted in all patients, mean 2.63grafts. 22 cases using whole venous grafts and 10 cases undergoing total arterial revasularization in coronary artery bypass grafting. Average extracorporeal circulation auxiliary time 55 min. Intra-aortic baUoon pump （1ABP）was used in 5 patients. 3 cases were death in early post-operative, 2 in low cardiac output syndrome and 1 in multiple organ failure respectively. The others had favorable outcomes. Conclusion Coronary artery bypass grafting is effective method treating with high-risk coronary patients. Suitable operation design, advanced myocardial protection during surgery, flexible using extracorporeal circulation,and 1ABP applied in early time can signjficantly improve the results of CABG for the high-risk patients.

关 键 词：体外循环 冠脉搭桥术 心脏不停跳 高危重症 

分 类 号：R654.2[医药卫生—外科学]