心脏不停跳下双桥技术治疗冠状动脉前降支弥漫性病变  

Off-pump double grafting in treatment of diffuse anterior coronary descending artery lesion

作　　者：李大连[1] 张永[1] 郭建中[1] 程智广[1] 李莹莹[1] 崔永超[1] 杨峰[1] 

机构地区：[1]首都医科大学附属北京友谊医院心脏中心心脏外科,北京100050

出　　处：《解放军医学院学报》2013年第10期1007-1009,共3页Academic Journal of Chinese PLA Medical School

摘　　要：目的：评价心脏不停跳冠脉搭桥“双桥”技术在冠状动脉前降支弥漫性病变治疗中的安全性和有效性。方法2008年10月-2012年12月，我院对36例前降支弥漫性病变患者在心脏不停跳下采用“双桥”技术治疗，其中男26例，女10例；年龄46~78（63.8±7.3）岁；双支病变3例，三支病变33例，其中合并左主干病变8例；术前欧洲心血管手术危险因素评分系统（European system for cardiac operative risk evaluation，EuroSCORE）评分为2~7（5.2±1.4）分；左心室射血分数为32.8%~65.0%（49.4±12.2）%。结果所有患者手术均成功，无住院死亡。其中左乳内动脉与前降支狭窄近端搭桥26例，桡动脉和大隐静脉与前降支狭窄近端搭桥分别为3例和7例；大隐静脉与前降支狭窄远端搭桥20例，桡动脉与前降支狭窄远端搭桥16例。平均搭桥3~5（3.2±0.6）支。术后平均呼吸机辅助通气时间、监护室停留时间和住院时间分别为6~16（11.3±2.9） h、9~22（16.5±4.2） h和5~9（6.9±1.4） d。平均随访0.5~4.8（2.8±1.4）年，所有患者均存活，无心绞痛发作。结论前降支“双桥”技术可以安全用于冠状动脉前降支弥漫性长病变患者的不停跳冠脉搭桥手术治疗，疗效可靠。Objective To assess the safety and efficiency of off-pump double grafting in treatment of diffuse anterior coronary descending artery lesion. Methods Of the 36 patients with diffuse anterior coronary descending artery lesion （26 males and 10 females） aged 46-78 （63.8±7.3） years who underwent off-pump double grafting in our hospital from October 2008 to December 2012, 3 were diagnosed with 2 coronary lesions and 33 were diagnosed with 3 coronary lesions including 8 with main left coronary lesion. Their EuroSCORE score was 5.2±1.4 （2-7） and their left ventricular ejection fraction was 32.8%-65.0%（49.4%±12.2%）. Results The operation was successful in all patients without death. Of the 36 patients, 26 underwent left mammary internal artery and anterior coronary descending artery bypass, 3 underwent radial artery and great sapphenous vein bypass, and 7 underwent anterior coronary descending artery bypass, 20 underwent great sapphenous vein and anterior coronary descending artery bypass, 16 underwent radial artery and anterior coronary descending artery bypass. The mean number of grafts was 3-5 （3.2±0.6）. The respirator-assisted ventilation time, ICU stay time, hospital stay time and follow-up time of the patients were 6-16 （11.3 ±2.9） h, 9-22 （16.5± 4.2） h, 5-9 （6.9±1.4） days and 0.5-4.8 （2.8±1.4） years, respectively. All the patients were survived with no angina pectoris occurred. Conclusion Off-pump double grafting is a safe and effective procedure for diffuse anterior coronary descending artery lesion.

关 键 词：左前降支 不停跳冠脉搭桥 序贯吻合 乳内动脉 大隐静脉 

分 类 号：R654.2[医药卫生—外科学]