急诊冠状动脉旁路移植术治疗经皮冠状动脉介入术中并发症的临床疗效观察  

Clinical outcomes of urgent coronary artery bypass grafting treating complications of intra-percutaneous coronary intervention

作　　者：吴震[1] 顾承雄[1] 刘长城[1] 方颖[1] 韦华[1] 宋伟[1] WU Zhen;GU Chengxioug;L;FANG Ying;WEI Hua;SONG Wei(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2018年第7期646-649,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81370436);北京市科委项目(Z131107002213003)

摘　　要：目的:评估冠心病患者经皮冠状动脉介入术(PCI)中并发症行急诊冠状动脉旁路移植术(CABG)的临床疗效。方法:回顾性分析我科2004年至2012年,PCI术中出现严重并发症行急诊CABG治疗的30例患者临床资料,男性12例,女性18例,年龄52~78岁,平均(66±8)岁。分析围术期并发症和3年随访的临床预后。结果:PCI并发症致心源性休克7例,恶性心律失常2例。术前IABP(主动脉球囊反搏)置入14例,ECMO(体外膜肺)辅助5例。发生PCI并发症至外科血运重建的时间为(130±28)min。30例均成功实施急诊CABG。围术期死亡6例,余患者治愈出院。3年随访,NYHA(心功能分级)Ⅰ-Ⅱ者高达83.3%,仅2例出现心力衰竭,NYHA Ⅲ级,1例猝死,1例死于脑梗死。与出院时比较,3年随访心功能显著改善(P<0.05)。结论:急诊CABG治疗PCI术中严重并发症近中期疗效尚可靠。Objective： To evaluate the clinical outcomes of urgent coronary artery bypass grafting（ CABG） for the coronary artery disease（ CAD） patients with severe complications during percutaneous coronary intervention（ PCI）. Methods： We retrospectively analyzed the clinical data of 30 patients with severe complications during PCI undergoing urgent CABG in our department from 2004 to 2012. There were 12 males and 18 females at the mean age of（ 66 ± 8） years ranging from 52-78 years. Perioperative complications and prognosis of post-CABG and three-year follow-up were assessed. Results： There were 7 patients and 2 patients suffered from cardiac shock and malignant arrhythmias respectively due to complications of intra-PCI. Before surgical intervention,14 patients were received IABP and 5 patients with assistance of ECMO. The time interval from PCI complications to surgical revascularization was（ 130 ± 28） minutes. All subjects were conducted urgent CABG successfully,6 patients died post-CABG while the others recovered from operation and were discharged. During three-year follow-up,the ratio of NYHA cardiac function class Ⅰ-Ⅱ was up to 83. 33%. Only two patients underwent heart failure with NYHA Ⅲ,and one died of sudden cardiac death and another one died of stroke. And there was a statistic difference in cardiac function between the phase of three-year follow-up and that of discharging（ P 〈 0. 05）. Conclusion： Short and medium-term efficacy of urgent CABG to treat complications of during PCI may be reliable.

关 键 词：冠心病 经皮冠状动脉介入术 并发症 急诊冠状动脉旁路移植术 

分 类 号：R54[医药卫生—心血管疾病]