非体外循环冠状动脉旁路移植术中转体外循环的原因探讨  

Exploration of conversion to cardiopulmonary bypass in off pump coronary artery bypass

作　　者：陈彧[1] 徐东[1] 陈生龙[1] 万峰[1] 

机构地区：[1]北京大学人民医院冠心病微创外科中心,100044

出　　处：《北京医学》2003年第3期191-194,共4页Beijing Medical Journal

摘　　要：目的　探讨非体外循环冠状动脉旁路移植术 (OPCAB)中转体外循环的原因与技术方法。方法　分析术前预计完成的非体外循环冠状动脉旁路移植术 4 34例 ,中转为体外循环下手术者 10例 (2 .3% )。中转原因包括 :顽固性心律失常 2例 ,搬动心脏时顽固低血压 2例 ,右冠急性阻塞缺血引起心率下降和血压降低 2例 ,心脏明显扩大而难以完全再血管化 2例 ,因完成的血管桥不通畅在体外循环下重新吻合 2例。结果　中转体外循环后 9例在并行循环心脏跳动下完成手术 ,1例在低温室颤下完成手术 ,体外循环时间为 (131.5± 4 0 .1)min。远端吻合口数目平均为 (3.5± 1.0 )个 ,使用主动脉内球囊反搏 6例。本组无住院死亡者。术后室颤 1例 ,除颤成功 ;房颤 2例 ,药物治疗好转。随访术后 6个月突发心律失常死亡 1例 ,考虑为晚期缺血性心肌病。结论　OPCAB手术存在中转体外循环的可能性。随着技术方法的改进和操作经验的积累 ,可减少中转事件的发生 ,进一步增加OPCAB的安全性和可行性。Objective To analyze the causes and methods of conversion to cardiopulmonary bypass (CPB) in off pump coronary artery bypass (OPCAB).Methods From September of 2000 to April of 2002 in 434 cases of preoperatively scheduled OPCAB, 10 cases (2.3%) were converted to CPB. The causes included:2 cases with severe arrhythmia,2 severe hypotension caused by lifting the heart,2 brachtardia and hypotension due to acute occlusion in right coronary artery, 2 with dilated heart impossible to totally revascularized and 2 for revision of the malfunctioned grafts.Results 9 cases were completed with beating heart assisted by CPB, the other with hypothermic ventricular fibrillation following CPB. The CPB time was (131.5±40.1)min. The number of distal anastomosis was 3.5±1.0. The intra aortic balloon pump was used in 6 cases.The hospital mortality was 0%.1 case developed ventricular fibrillation on the 1st postoperative day and was defibrillated successfully.No other severe complications happened.1 case with ischemic myopathy died of fatal arrhythmia in follow up.Conclusions This study confirms the possibility of conversion to CPB in scheduled OPCAB surgery.The surgeons' accumulating experience and the improvement of technology and skills will help to reduce the possibility and strengthen the safety and feasibility in OPCAB.

关 键 词：非体外循环冠状动脉旁路移植术 体外循环 并行循环心脏跳动 低温室颤 主动脉内球囊反搏 

分 类 号：R654.1[医药卫生—外科学]