Enclose Ⅱ主动脉近端吻合装置在非体外循环冠状动脉旁路移植术中的临床应用  

Clinical application of Enclose II proximal aortic anastomosis assist device in off-pump coronary artery bypass grafting

作　　者：王圣[1] 程兆云[1] 赵子牛[1] 权晓强[1] 魏宇[1] 赵亮[1] 杨雷一[1] 

机构地区：[1]河南省人民医院心血管外科,郑州450003

出　　处：《岭南心血管病杂志》2015年第5期628-631,共4页South China Journal of Cardiovascular Diseases

基　　金：国家临床重点专科建设项目经费资助(2011)

摘　　要：目的总结应用EncloseⅡ主动脉近端吻合装置行非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCAB）治疗合并升主动脉钙化的冠状动脉粥样硬化性心脏病（冠心病）患者的临床处理经验。方法回顾分析2010年6月至2012年12月收治的合并升主动脉钙化的冠心病患者260例,所有患者在OPCAB术中升主动脉近端吻合时均采用EncloseⅡ主动脉近端吻合装置;其中男166例,女94例;年龄65.8（42~78）岁。大隐静脉与升主动脉近端共完成246个吻合口,右乳内动脉与升主动脉近端共完成30个吻合口,桡动脉与升主动脉近端共完成24个吻合口,升主动脉近端吻合口1~3个/例。术后观察神经系统并发症的发生情况,冠状动脉计算机断层扫描血管造影检查桥血管通畅情况。结果 260例手术均顺利完成,围术期死亡5例。急性心肌梗死并发低心排血量综合征3例（死亡2例）,急性肾功能衰竭4例（死亡2例）,呼吸功能衰竭并死亡1例,二次开胸止血2例,心房纤颤2例,切口感染1例;无1例吻合口漏血,无神经系统并发症发生。随访248例（随访率97.2%）,随访3个月~1年,失访7例,随访期间者无1例患心绞痛再发,无1例主动脉夹层动脉瘤发生,未出现脑卒中、失语、意识障碍等精神神经系统并发症。冠状动脉计算机断层扫描血管造影检查桥血管均通畅。结论对合并升主动脉钙化的冠心病患者,在OPCAB术中应用EncloseⅡ主动脉近端吻合装置,可有效地减少术后神经系统并发症的发生,取得了较好的近期临床效果。Objectives To summarize the experience on the use of Enclose II proximal aortic anastomosis assist device in off-pump coronary artery bypass grafting in patients who suffered coronary artery disease combined with aortic calcification. Methods Retrospective analysis on 260 patients（male 166, female 94） with coronary artery disease combined with aortic calcification, aging from 42 to 78（mean 65.8） years, undergoing off-pump coronary artery bypass grafting with Enclose II device from June 2010 to December 2012 was carried out. A total of 246 proximal aortic anastomosis were constructed with saphenous vein, 30 anastomosis with free right internal mammary artery and 24 anastomosis with radial artery, with 1-3 proximal anastomosis per patient. Occurrence of postoperative neurological complications were observed and graft patency was evaluated by computed tomography angiography（CTA）. Results All of the 260 cases underwent successful surgery and 5 perioperative death occurred. Three cases suffered perioperative acute myocardial infarction and low cardiac output syndrome, of which, 2 cases died; 4 cases suffered postoperative acute renal failure, of which, 2 cases died; 1 case suffered respiratory failure and died; 2 cases underwent reoperation for bleeding; 2 cases suffered postoperative atrial fibrillation and 1 case got incision infection. No anastomotic bleeding or neurological complications occurred. A follow-up on 248 cases（97.2%） from 3 months to 1 year showed that no angina, aortic dissection, stroke, anepia or disturbance of consciousness occurred. Coronary CTA revealed good graft patency rates. Conclusions The use of Enclose II device in off-pump coronary artery bypass grafting surgery in patients with coronary artery disease combined with aortic calcification can effectively reduce the incidence of postoperative neurological complications, and reveals good early clinical outcomes.

关 键 词：升主动脉钙化 非体外循环冠状动脉旁路移植术 主动脉近端吻合装置 

分 类 号：R543.4[医药卫生—心血管疾病]