微创冠状动脉旁路移植术处理前降支病变的围术期结果  

Perioperative results of minimally invasive direct coronary artery bypass grafting for left anterior descending artery revascularization

作　　者：张振 刘健 曾庆诗 谢斌 郭惠明 ZHANG Zhen;LIU Jian;ZENG Qingshi;XIE Bin;GUO Huiming(Department of Cardiac Surgery,Guangdong Provincial People's Hospital,Guangdong Provincial Academy of Medical Sciences,Guangdong Provincial Institute of Cardiovascular Diseases,Guangzhou,510000,P.R.China)

机构地区：[1]广东省人民医院,广东省医学科学院,广东省心血管病研究所心外科,广州510000

出　　处：《中国胸心血管外科临床杂志》2021年第2期198-201,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省农村科技特派员重点派驻项目(KTP2020325);广东省登峰计划项目(DFJH201802);广东省科技计划项目(2017B090904034,2017B030314109,2018B090944002,2019B020230003)。

摘　　要：目的研究胸腔镜辅助下经左胸小切口微创直视下冠状动脉旁路移植术(minimally invasive direct coronary artery bypass grafting,MIDCAB)处理前降支病变的围术期结果及其安全性。方法回顾性分析2014年5月至2018年10月在我院接受MIDCAB 92例患者的临床资料,其中男72例(78.26%),年龄42~78(61.29±7.48)岁,女20例(21.74%),年龄30~80(61.30±12.26)岁。分析围术期并发症发生率、血制品使用情况、左心功能变化情况、呼吸机使用时间、住ICU时间及住院时间等指标。结果2例(2.17%)患者中转正中开胸手术,5例(5.43%)术中输入血液制品,2例(2.17%)二次开胸止血,4例(4.34%)术后低氧血症,1例(1.08%)再次气管插管。呼吸机使用时间3~227(22.35±35.39)h,住ICU时间16~777(78.85±108.62)h,术后住院时间2~36(8.86±6.05)d。住院死亡1例(1.08%)。结论MIDCAB处理前降支病变具有较好的围术期结果,尤其适用于孤立性前降支病变,可缩短术后呼吸机使用时间、减少血液制品使用、缩短住ICU时间及住院时间。Objective To investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting(MIDCAB)treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy.Methods The clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed,including 72(78.26%)males aged 42-78(61.2±7.48)years,and 20(21.74%)females aged 30-80(61.30±12.26)years.The perioperative complications,blood product use,left heart function changes,ventilator use time,ICU stay,hospital stay and other indicators were analyzed.Results Two(2.17%)patients were transferred to thoracotomy,5(5.43%)patients received blood products during the operation,2(2.17%)were subjected to secondary thoracotomy to stop bleeding,4(4.34%)had postoperative hypoxemia and 1(1.08%)was reintubated.The ventilator use time was 3-227(22.35±35.39)hours,the ICU stay was 16-777(78.85±108.62)hours,and the postoperative hospital stay was 2-36(8.86±6.05)days.One(1.08%)patient died in hospital.Conclusion MIDCAB for anterior descending artery disease has good perioperative results,especially for solitary anterior descending artery disease,which can reduce the use of blood products,and shorten the time of ventilator use after operation,ICU stay and hospital stay.

关 键 词：冠状动脉旁路移植术 微创小切口 前降支 冠状动脉病变 手术 

分 类 号：R654.2[医药卫生—外科学]