冠状动脉旁路移植术1077例临床分析  

Clinical analysis of 1077 casas of caronary artery bypass grafting

作　　者：马黎明[1] 程前进[1] 李祥[1] 刘高利[1] 赵永亮[1] 李庆臣[1] 武庆全[1] 朱心愿[1] 刘斌[1] 褚衍林[1] 

机构地区：[1]山东省医药卫生重点学科心血管疾病研究诊治中心济宁医学院附院心脏外科

出　　处：《心肺血管病杂志》2014年第5期713-715,共3页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：探讨冠状动脉旁路移植术（CABG）指征、时机、危险因素及并发症防治。方法：选择2003年1月至2013年3月,我院施行CABG患者1 077例,其中体外循环下CABG（CCABG）1 027例,非体外循环CABG（OPCAB）50例。术前不稳定性心绞痛患者834例,60岁以上者671例（62.3%）。合并其他疾病患者854例（79.3%）。左主干病变343例;3支或3支以上病变955例。左乳内动脉旁路移植992例,使用率92.1%（992/1077）。围术期使用主动脉内气囊反搏36例。结果：死亡10例（0.99%）,分别死于低心排出量综合征（低心排）、心室颤动、感染性休克、脑干梗死、肾衰竭、消化道出血及多脏器衰竭。随访2-96个月,获访941例（88.2%）。结论：合理掌握手术指征、时机,严密术后监测和及时并发症防治,可使CABG术的病死率和并发症明显下降。Objective： To analyze retrospectively 1 077 patients who underwent coronary artery bypass grafting surgery（ CABG） in order to discuss appropriately operative indication,chance,risk factors for mortalit and pireoperative management.. Methods： 1 027 patients who underwent conventional CABG surgery on pump（ CCABG） and 50 patients who underwent off-pump CABG（ OPCAB） were collected and analyzed retrospectively between March 2003 and March 2013. 834 patients had unstable angina,671 Patients was over 60 yars old（ 62.3%） and 854 ptients had concomitant diseases（ 79.3%）.343 patients had left main stem（ LIMS） stenosis and 955 patients,triple-vessel disease. Left internal mammary artery use was in 992 patients（ 92. 1%）. 36 patients were implanted intra-aortic ballon pump pireoperatively. Results： There were 10（ 0. 99%） cases death of postoperative ventricular fibrillation,septic shock,gastrointestinal bleeding,cerebral infarction,low cardiac output,renal filure,cereboembolism,and multiple organ failure respectively. Follow-up 1 to 96 months,there was 6death in which 3 death of cardiac factors,and 3 other. Conclusion： According to characteristic of patient,appropriately operative indication and chance,and trengthening management of postoperative complication may make the mortality and morbidity decrease significantly.

关 键 词：冠状动脉旁路移植术 冠状动脉硬化 乳内动脉 治疗效果 

分 类 号：R54[医药卫生—心血管疾病]