冠脉搭桥合并瓣膜手术中不停跳冠脉搭桥心肌保护技术的应用  

Myocardial protection technique for off-pump coronary artery bypass grafting combined with valve surgery

作　　者：陈林 程可洛 吴家园 蔡小碧 梁柱 林立尧 

机构地区：[1]广东医科大学附属医院胸心外科,广东湛江524001

出　　处：《局解手术学杂志》2017年第11期838-841,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探究冠脉搭桥合并瓣膜手术中不停跳冠脉搭桥心肌保护技术的应用。方法以本院2015年2月至2017年3月来我院心胸外科进行冠脉搭桥合并瓣膜手术的45例患者作为研究对象,所有患者在手术过程中采用不停跳冠脉搭桥心肌保护技术,观察手术前后患者心功能评级、彩超结果对比以及出院情况,对该方法进行评价。结果手术前后对比,左心室射血分数差异无统计学意义(P>0.05);左室舒张末前后径和左房舒张末前后径术后7 d显著低于术前,差异有统计学意义(P<0.05);术后随访3个月发现,Ⅰ级和Ⅱ级心功能显著增加29例,3个月后的心脏功能分级(NYHA)显著优于手术前,差异有统计学意义(P<0.05);术后出现1例纵隔感染和1例切口愈合不佳,经过积极治疗,患者均痊愈出院。结论不停跳心肌保护技术能够在冠脉搭桥合并瓣膜手术中对整体手术过程起到重要的支持,能够保证手术疗效。Objective To investigate the application of myocardial protection technique in of-pump coronary artery bypass grafting（CABG） combined with valve surgery- Metliods Forty-five patients who received CABG combined valve surgery in the cardiothoracic sur-gery department of our hospital from February 2015 to March 2017 were as the research object. All of protection technique in off-pump CABG combined with valve surgery. The preoperative and postoperative heart function rating and color ultra results and surgical patients discharged to evaluate the method. Results There was no difference in left ventricular ejection fraction before and after surgery（ P 〉 0. 05 ） . left ventricular end diastolic diameter and left atrial end diastolic diameter at 7 days ater operation was signifi-cantly lower than those before operation, the differences were significant（ P 〈 0. 05 ） . After followed up for 3 months, the level I and level n of cardiac function increased significantly in 2/ cases,heart function classification（ NYHA） after 3 months was significantly better than that be-fore the surgery,the difference was significant（P 〈0. 05） . Mediastinal infection occurred in 1 case and poor healing of wound in 1 case,heal-ing after active treatment. Conclusion Myocardial protection technique in off-pump CABG combined with valve surgrole in the whole surgical process and ensures the operation effect.

关 键 词：冠脉搭桥 瓣膜手术 不停跳搭桥心肌保护技术 临床疗效 

分 类 号：R654.1[医药卫生—外科学]