非体外循环冠状动脉旁路移植术治疗冠心病的疗效分析  

The curative effect of off-pump coronary artery bypasses grafting in the treatment of coronary artery disease

作　　者：刘胜中[1] 谭今[1] 向波[1] 蒋露[1] 于涛[1] 黄克力[1] 

机构地区：[1]四川省医学科学院.四川省人民医院心脏外科中心,四川成都610072

出　　处：《实用医院临床杂志》2016年第1期19-25,共7页Practical Journal of Clinical Medicine

摘　　要：目的总结非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）治疗冠心病的临床经验,评价其疗效和安全性。方法回顾性分析2012年4月至2015年9月在四川省人民医院心脏外科中心接受OPCABG治疗的119例冠心病患者的临床资料。结果全组手术均顺利完成,搭桥（2.97±0.24）支,左侧乳内动脉桥63支,大隐静脉桥288支;手术时间、术后呼吸机辅助时间、术后ICU入住时间和术后住院时间分别为（301.5±52.8）min、（14.3±6.2）h、（23.6±8.4）h和（12.8±6.1）d。术后并发低心排8例、急性肾衰4例、急性心梗1例、肺部感染6例、再次开胸止血2例、胸骨裂开4例、脑梗塞3例、消化道出血2例、下肢切口愈合不良6例;使用主动脉内球囊反搏辅助11例,床旁透析治疗4例;住院死亡5例,死亡率4.2%。114例随访1-39个月[（17.9±10.2）月],3例死亡;25例经冠脉CTA或冠脉造影检查证实14支乳内动脉桥通畅（100%,14/14）,57支大隐静脉桥通畅（89.06%,57/64）;3例因心绞痛复发行经皮冠脉介入术,其余患者生活质量良好,超声心动图显示心功能不同程度改善。结论 OPCABG治疗冠心病安全有效,保障桥血管通畅、维护左心室功能、防治并发症是提高手术疗效的关键。Objective To summarize the clinical experiences of off-pump coronary artery bypass grafting （OPCABG） for patients with coronary artery disease,and evaluate its effect and safety. Methods The clinical data of 119 patients with coronary artery disease treated with OPCABG from April 2012 to September 2015 in our center were retrospectively analyzed. Results All OPCABG was successfully performed. The average number of distal anastomoses per patient was 2.97 ± 0. 24 including 63 branches of left internal mammary artery grafts and 288 branches of great saphenous vein grafts. The operation time, postoperative ventilator support time, postoperative ICU stay time and postoperative hospitalization time were （301.5 ± 52. 8） minutes, （ 14. 3 ± 6. 2） hours, （23.6 ± 8.4） hours and （12. 8 ± 6. 1 ） days,respectively. The postoperative complications included 8 cases with low cardiac output syndrome,4 with acute renal failure, 1 with acute myocardial infarction,6 with pulmonary infection,2 with re-thoratomy for hemostasis,4 with sternal dehiscence,3 with cerebral infarction,2 with digestive tract bleeding and 6 with poor lower limbs wound healing. There were 11 patients receiving intra-aortic balloon pump （IABP） support for low cardiac output syndrome and malignant arrhythmias ,and 4 patients receiving bedside dialysis for acute renal failure. Five patients died in hospital and the mortality rate was 4. 2%. There were 1 ld patients were followed up after discharge for 1 ± 39 with average （ 17. 9 ± 10. 2） months. During the follow-up,3 patients died. By using coronary artery computer tomography angiography or coronary angiography in 25 cases, 14 branches of internal mammary artery grafts were patency （100%, 14/14） and 57 branches of great saphenous vein grafts were patency （89.06% ,57/64）. There were 3 patients receiving percutaneous coronary intervention due to angina relapse. The rest of patients had a good quality of life and their heart function was improved in various degrees shown by

关 键 词：非体外循环冠状动脉旁路移植术 冠心病 疗效 

分 类 号：R654.2[医药卫生—外科学]