冠状动脉旁路移植术后围术期心肌缺血  

Perioperative Myocardial Ischemia after Coronary Artery Bypass Grafting

作　　者：吴洪斌[1] 胡盛寿[1] 吴清玉[1] 朱晓东[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2002年第4期237-239,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的　　探讨冠状动脉旁路移植术 (CABG)术后出现围术期心肌缺血 (PMI)的相关危险因素及其处理措施。　方法　回顾性总结 2 6 80例 CABG患者的临床资料 ,并根据术后是否发生 PMI将其分为 PMI组 (30例 )和非PMI组 (2 6 5 0例 ) ,分析 CABG后出现 PMI的危险因素。　结果　 PMI组中 11例进行急诊再血管化 ,其余行主动脉内球囊反搏 (IABP)或药物治疗 ;院内死亡 7例 ,死亡率为 2 3.3%。心绞痛症状缓解 2 2例 ,心电图完全或部分复原 9例 ,残留心肌梗死改变 14例。非 PMI组院内死亡 5 8例 ,死亡率为 2 .2 %。两组死亡率之间比较差别具有显著性意义(χ2 =5 6 .0 4 ,P=0 .0 0 1)。多因素分析表明 ,术前无心肌梗死史、冠状动脉弥漫性病变和术中内膜剥脱为相关危险因素。结论　 PMI是 CABG术后一种比较危险的并发症 ,严重者可危及生命 ,及早诊断和适当的治疗尤为重要 ,对于因旁路血管堵塞造成的 PMI,急诊再次血管移植是挽救患者生命的必要措施。ObjectiveTo assess the diagnosis and treatment of perioperative myocardial ischemia (PMI) after coronary artery bypass grafting (CABG). MethodsThe clinical data of 2 680 CABG patients were reviewed, and were divided into two groups, PMI group (n=30) and no PMI group (n=2 650). Using multivariate analysis, the risk factors of mortality and morbidity were detected.ResultsIn PMI group, 11 patients underwent coronary reoperation and others were treated with intra-aortic balloon counterpulsation (IABP) and medicine. Seven patients died in the hospital, the mortality was 23.3%, in which was 2.2% in no PMI group (χ2=56.04,P=0.001). No infarction history, extensive coronary artery disease and endarterectomy were independent risk factors in multivariate analysis. ConclusionsPMI is a severe complication after CABG. Early diagnosis and treatment is important. Coronary reoperation should be used promptly.

关 键 词：冠状动脉旁路移植术 围术期 心肌缺血 

分 类 号：R654.2[医药卫生—外科学] R542.2[医药卫生—临床医学]