激光心肌血运重建辅助冠脉旁路移植治疗严重冠心病的研究  

Study of coronary artery bypass combined transmyocardial laser revascularization of severe coronary artery disease

作　　者：朱玮 黄伯湘[1] 郑远[1] 林冬群[1] 陈静薇[1] 林宇[1] 阮新民[1] 胡佳心[1] ZHU Wei;HUANG Boxiang;ZHENG Yuan;LIN Dongqun;CHEN Jingwei;LIN Yu;RUAN Xinming;HU Jiaxin(Second Cardiovascular Department,Guangdong Province Hospital of Traditional Chinese Medicine,Guangzhou 510106,China)

机构地区：[1]广东省中医院大学城医院心血管二科,广州510106

出　　处：《广州医药》2020年第3期31-35,共5页Guangzhou Medical Journal

摘　　要：目的探讨激光心肌血运重建(Transmyocardial Laser revascularization,TMLR)辅助冠状动脉旁路移植术治疗严重冠心病的临床疗效及11年随访结果。方法25例严重冠心病患者行不停跳冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)并辅以激光心肌血运重建术(TMLR组),回顾性总结了其术前、术中、术后及11年随访资料,并与同期进行的95例单纯不停跳冠状动脉旁路移植术(OPCAB组)病人资料进行比较分析。结果TMLR组在平均远端吻合口数比OPCAB组少,而手术时间、术后硝普钠用量比OPCAB组多,其他如术后机械通气时间、ICU停留时间、术后住院天数和术后常见并发症,2组之间均无差异;平均11年随访资料中,胸闷痛、心衰、新出现ST-T改变发生率、再发急性心梗、再次PCI处理、LVEF和血管桥闭塞率,2组间无明显区别;死亡率二者之间也没有区别。结论TMLR术辅助冠状动脉旁路移植术虽然手术时间比较长,血管活性药物应用较多,但术后康复和11年随访资料显示与单纯OPCAB术有相似的结果,说明TMLR术作为冠状动脉旁路移植术的补充,对那些冠脉血管细小且钙化狭窄严重而不适合冠状动脉旁路移植术的冠心病患者是获益的。Objective To explore and analyze the clinical effect of off-pump coronary artery bypass(OPCAB)combined transmyocardial laser revascularization(TMLR)of severe coronary artery disease and 11 years follow-up.Methods 25 cases with sever coronary artery disease were treated through OPCAB and TMLR,and the clinical data and 11 years follow-up data were summarized and analyzed retrospectively,compared with the data of the patients treated by only OPCAB.Results There were less mean bypass graft numbers in TMLR group than in OPCAB group.Operation time and the amount of sodium nitroprusside in TMLR group were more than that in OPCAB group.But intubation time,ICU stay time,postoperative stay time and postoperative common complications were not different between two groups.11 years postoperative follow-up results indicated that chest pain,heart disfunction,ST-T alteration,AMI,PCI treatment again,LVEF and bypass graft occlusion rate were not obviously between two groups.Conclusion TMLR combined OPCAB may result in good outcome and improve long term survival.

关 键 词：不停跳冠脉搭桥术 激光心肌血运重建术 术后随访 

分 类 号：R654.2[医药卫生—外科学]