连续1052例冠心病手术无死亡的临床经验

目的 总结冠心病外科治疗无死亡的临床经验.方法 回顾性分析2006年1月至2010年3月在阜外医院完成冠心病外科手术治疗1052患者例临床资料.结果 全组950例(90.3％)行非体外循环冠状动脉旁路移植术( OPCAB),102例(9.7％)行体外循环冠状动脉旁路移植术(on-pump CABG).术前患者EuroScore( 3.4±2.6)分,＞6分者127例(12.0％).平均旁路移植血管为(3.2±0.9)支,术后平均住院(7.7±2.5)天.术后并发症包括二次开胸探查14例,呼吸道感染8例,心功能不全IABP支持6例,急性肾功能不全5例.全组患者住院期间无死亡,均治愈出院.结论 制定个体化治疗措施,加强围术期管理,结合技术创新,冠心病手术结果满意.

Surgical treatment for consecutive 1052 coronary heart disease patients without death

Objective In order to improve the outcome of surgical treatment for atherosclerotic heart disease,we summarize our clinical experience of surgical treatment during the last four years and propose our therapeutic strategy.Methods A retrospective study was performed including consecutive 1052 patients receiving isolated or combined CABG surgery which was performed by a single surgical team from January 2006 through March 2010 at Fu Wai Hospital.Patients'characters were quantified by European score System for cardiac operative risk evaluation (EuroSCORE).Operative strategies were classified as candioplegic arrest,on-pump beating,isolated off-pump,and the hybrid procedures to treat the concomitnnt diseases,such as peripheral vascular disease,atrial fibrillation,congenital heart diseases,et al.Clinical data including the surgical indications,preoperative patient co-morbidity,postoperative clinical course,and perioperative outcomes were analyzed of.Results Patients showed a mean EuroSCORE of 3.4 ±2.6.There were 127 patients ( 12％ ) with a EuroSCORE ＞6.The mean age of the patients was(61.2 ± 9.5 ) years,ranging from 26 to 84 years.The overall in-hospital postoperative mortality rate was 0％,and all patients had an uneventful recovery course and discharged.The transfusion rate was 31.9％.950 patients (90.3％)were OPCAB and 102 (9.7％) were on-pump CABG.There were 87 patients underwent concomitant CABG and heart valvereplacement or repair.21 patients underwent hybrid procedure by simultaneous peripheral artery stenting and OPCAB,and 14patients underwent redo CABG.The Average number of distal anastomoses was 3.2 ±0.9,and the mean postoperative hospital stay was (7.7 ± 2.5 ) days.Fourteen patients had re-exploration for bleeding,8 with pneumonia,5 with acute renal insufficiency and 6 had intra-aortic balloon pump (IABP) for cardiac dysfunction.All these patients recovered after proper treatment.Conulusion Surgical treatment for the coronary heart disease could achieve satisfactory curative effects by the individualized treatment,technological innovation and strengthen perioperative management.Excellent results and low major complications in the perioperative coupe could be expected through this strategy.