冠状动脉旁路移植术治疗围手术期难治性冠状动脉痉挛临床分析  

Coronary artery bypass grafting for perioperative refractory coronary artery spasm

作　　者：刘诚 李温斌 师启众[1] 张占海[2] 陈国锋 齐恒田[1] 王飞 樊宏哲[1] 张保全[1] 王可强 LI Wenbin;SHI Qizhong;ZHANG Zhanhai;CHEN Guofeng;QI Hengtian;WANG Fei;FAN Hongzhe;ZHANG Baoquan;WANG Keqiang(Department of Cardio Thoracic Surgery,The Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,China)

机构地区：[1]新乡医学院第三附属医院心胸外科,453003 [2]南阳医学高等专科学校第一附属医院 [3]郑州第七人民医院-郑州市心血管病医院

出　　处：《心肺血管病杂志》2020年第5期582-585,589,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨冠状动脉旁路移植术(CABG)治疗难治性冠状动脉痉挛(CAS)的可行性和有效性。方法:对2018年6月至2019年12月,在临床心脏外科工作中遇到的4例围手术期难治性CAS患者进行回顾性分析。4例患者均为原计划心脏手术完成后并发的急性CAS,出现血流动力学不稳定,药物治疗无效后被迫进行CABG。4例患者年龄43~63岁,男性3例,女性1例。冠状动脉肌桥1例,行冠状动脉前降支肌桥松解术;主动脉瓣重度反流1例,行主动脉瓣置换术;冠心病2支病变1例,行CABG术;急性心肌梗死并发室间隔穿孔(VSR)1例,行VSR旷置术。结果:4例患者均被迫行CABG,术后患者未再出现CAS表现,除AVR患者术后发生急性I型主动脉夹层死亡外,其他3例均恢复良好,随访3~18个月,患者均未再发生CAS表现。结论:CABG可能是治疗难治性CAS—种可行而且有效的外科治疗方法。Objective:To investigate the feasibility and effectiveness of coronary artery bypass grafting(CABG)in the treatment of refractory coronary artery spasm(CAS).Methods:A retrospective analysis of 4 cases of perioperative refractory CAS encountered by the author(correspondent author)in clinical cardiac surgery during 2018.06-2019.12.These 4 patients were all acute CAS patients who had undergone the planned cardiac surgery.They had hemodynamic instability,and were forced to undergo CABG after ineffective medication.Four patients were 43-63 years old,three were male and one was female.Diagnosis:one case of coronary artery bridge,anterior descending coronary artery bridge release;one case of severe aortic valve regurgitation,aortic valve replacement;one case of coronary heart disease,CABG operation;One patient with acute myocardial infarction complicated by ventricular septal rupture(VSR)underwent VSR excision.Results:All 4 patients were forced to undergo CABG,and no CAS findings occurred after the operation.Except for the acute type I aortic dissection death in patients with AVR,the other 3 patients recovered well,and the patients were not followed up for 3-18 months.Recurrence of CAS performance.Conclusions:CABG may be a feasible and effective surgical treatment for refractory CAS.

关 键 词：心脏外科 冠状动脉旁路移植术 冠状动脉痉挛 

分 类 号：R54[医药卫生—心血管疾病]