影响非体外循环冠脉搭桥手术的原因探讨

目的　探讨非体外循环冠脉搭桥术被迫改变为体外循环下施术的原因和处理、预防措施。方法　 1999～2 0 0 1年不完全统计 OPCAB手术 143例 ,术中 2 3例出现严重影响手术继续进行的心律失常、血压波动 ,其中 6例 (3% )术中被迫转变为体外循环下施术 ,其直接原因是 :1不能转复的严重心律失常 (4例 )。 2不能耐受显露靶血管牵拉心脏而出现持续性血压下降 (2例 )。结果　紧急转变为体外循环下完成手术。无手术死亡和术后早期严重并发症发生。结论　术前准备不充分、手术适应证选择不当和术中对意外情况处理欠妥与发生术中被迫改变术式有关

Investigation of Causes Affecting the Process of Off Pump Coronary Artery Bypass Grafting

Objective To investigate causes of off pump coronary artery bypass grafting being forcedly changed to cardiopulmonary bypass grafting during operation and methods to deal with and prevent them.Methods Incompletely statistical 143 patients operated by OPCAB between 1999 and 2001 were collected,23 of which suffered from severe arrhythmia and fluctuation of blood pressure during operation,with 6 of the 23(3%) patients being forcedly operated under cardiopulmonary bypass.The direct causes were: 1.irreversible arrhythmia(4 cases);2.continuous dropping of blood pressure (2 cases) due to being unable to tolerate dragging of heart by attempt to unfold the blood vessels.Results Cardiopulmonary bypass was performed immediately instead of OPCAB and there was no occurrence of death and early postoperative complications.Conclusion Inadequate preoperative preparation,improper selection of surgical indication and inappropriate treatment to the accident during operation were related to the forced change of operative method during operation.