主动脉内球囊反搏辅助不停跳冠状动脉旁路移植术在缺血性心肌病治疗中的应用  

Off-pump coronary artery bypass graft surgery assisted with intra-aortic balloon pump in the surgical treatment of ischemic cardiomyopathy

作　　者：方颖[1] 韦华[1] 吴震[1] 宋伟[1] 顾承雄[1] Fang Ying;Wei Hua;Wu Zhen;Song Wei;Gu Chengxiong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《首都医科大学学报》2018年第6期933-936,共4页Journal of Capital Medical University

基　　金：国家自然科学基金(81370436)~~

摘　　要：目的评价术中辅助应用主动脉内球囊反搏(intra-aortic balloon pump,IABP)在不停跳冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)中治疗缺血性心肌病中的疗效和安全性。方法回顾性分析2012年1月至2017年12月间完成的72例的辅助应用IABP的OPCAB治疗缺血性心肌病患者的治疗效果及预后转归情况。结果 72例患者均在IABP辅助下成功完成OPCAB,无一例转为体外循环下手术。平均每例搭桥(3. 8±1. 2)根,其中40例(55. 5%)患者术中出现心律失常,经调整固定器位置并喷洒硝酸甘油及利多卡因混合液后,其中36例心律失常好转。72例患者均康复出院,平均IABP辅助时间为(29. 4±18. 3) h,所有病例均未报道严重合并症。63例患者术后半年至1年复查心功能均有不同程度改善,平均左心室射血分数较术前明显提高(0. 45±0. 08 vs 0. 33±0. 05,P <0. 05),左心室舒张期末内径较术前显著缩小[(52. 3±7. 9) mm vs (63. 5±8. 7) mm,P <0. 05]。结论术中辅助应用IABP行OPCAB用于治疗缺血性心肌病是一种可行且相对安全的手术方式。Objective To evaluate the effect and safety of off-pump coronary artery bypass graft surgery(OPCAB)assisted with intra-aortic balloon pump(IABP)in the surgical treatment of ischemic cardiomyopathy.Methods This retrospective study analyzed the clinical data collected from72patients with ischemic cardiomyopathy,who were operated on the OPCAB surgery assisted with IABP from January2012to December2017in Beijing Anzhen Hospital.Results All patients accepted the OPCAB surgery under the assist of IAPB successfully.The average bypass grafts were3.8±1.2,forty(55.5%)cases,experienced arrhythmias during the surgery and thirty-six got better after dealing with nitroglycerin and lidocaine.All patients were discharged from hospital after recovery,with an average IABP auxiliary time of(29.4±18.3)h.Sixty-three patients were followed-up for0.5to1year.The mean left ventricular ejection fractions increased significantly(0.45±0.08vs0.33±0.05,P<0.05),while mean left ventricular end-diastolic diameter decreased remarkably[(52.3±7.9)mm vs(63.5±8.7)mm,P<0.05].Conclusion Our study showed that the OPCAB surgery assisted with IABP is an effective and relatively safe surgical treatment of ischemic cardiomyopathy.

关 键 词：主动脉内球囊反搏 缺血性心肌病 冠状动脉旁路移植术 非体外循环 

分 类 号：R541[医药卫生—心血管疾病]