不停跳冠状动脉旁路移植术在大左室冠状动脉粥样硬化性心脏病患者中的应用  

Application of off-pump coronary artery bypass grafting surgery in coronary artery disease patients with dilated left ventricle

作　　者：汪永义[1] 薛松[1] 徐根兴[1] 黄日太[1] 连锋[1] 李伟[1] WANG Yongyi;XUE Song;XU Genxing;HUANG Ritai;LIAN Feng;LI Wei(Department of Cardiovascular Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai,200127,P.R.China)

机构地区：[1]上海交通大学医学院附属仁济医院心血管外科,上海200127

出　　处：《中国胸心血管外科临床杂志》2020年第5期544-547,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析大左室冠状动脉粥样硬化性心脏病(冠心病)患者行不停跳冠状动脉旁路移植术(OPCABG)的方法和疗效。方法回顾性分析上海交通大学医学院附属仁济医院心血管外科2008年1月至2018年12月左室舒张期末直径(LVEDD)>60 mm行OPCABG患者303例的临床资料,其中男205例、女98例,年龄45~87(66.9±9.3)岁。结果平均肺动脉压力>25 mm Hg的患者90例,16例术中紧急转机行并行下OPCABG,21例手术开始即行并行下OPCABG,35例在围术期置入主动脉内球囊反搏(IABP);4例术中紧急转机的患者围术期死亡。术后6个月,该组患者LVEDD和左心室射血分数有明显改善。结论OPCABG对于大左室冠心病患者是一种安全有效的治疗手段。然而,对于肺动脉压力较高,左室形态为球形的患者,有较高的术中紧急转机可能。对于此类患者,必要时手术开始时即可行体外循环并行下OPCABG。Objective To describe our experiences of application of off-pump coronary artery bypass grafting surgery(OPCABG)in coronary artery disease(CAD)patients with dilated left ventricle.Methods A retrospective analysis of 303 patients with dilated left ventricle[left ventricular end-diastolic diameter(LVEDD)>60 mm]who underwent OPCABG from January 2008 to December 2018 at a single center was conducted.There were 205 males and 98 females at age of 45-87(66.9±9.3)years.Results The mean pulmonary artery pressure in 90 patients was more than 25 mm Hg.Sixteen patients underwent OPCABG with emergent transition of extracorporeal circulation(CPB).Twenty-one patients underwent OPCABG with CPB at the beginning of CABG.Thirty-five patients underwent intraaortic balloon counterpulsation(IABP).Four patients died during in-hospital time with the experience of emergent transition of CPB.Six months after operation,LVEDD and left ventricular ejection fraction(LVEF)were improved.Conclusion OPCABG is a safe and effective alternative for CAD patients with dilated left ventricle.However,for patients with higher pulmonary pressure and a spherical left ventricle after cardiac reshaping,there is a high risk of emergent transition of CPB during OPCABG;for this kind of patients,it is necessary to start CPB at the beginning of OPCABG.

关 键 词：大左室 冠状动脉粥样硬化性心脏病(冠心病) 不停跳冠状动脉旁路移植术 外科手术 

分 类 号：R654.2[医药卫生—外科学]