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1.
微创冠状动脉旁路移植术 总被引:26,自引:0,他引:26
目的:探讨非正中胸壁小切口,非体外循环下冠状动脉旁路移植术(CABG)的适应证和手术方法,并报告13例手术结果。方法:13例患者年龄42~66(平均54.5±8.3)岁,有脑血管意外病史者1例,有陈旧性心肌梗塞者4例,合并心功能不全者1例,合并高血压者9例,合并糖尿病者2例。单次和多次经皮冠状动脉腔内成形术(PTCA)后再狭窄各1例。手术在全麻下进行。其中左前外切口11例,右前外切口1例,左胸骨旁切口1例。左乳内动脉与前降支单支移植11例,右乳内动脉与右冠状动脉单支移植1例,左乳内动脉与前降支移植合并大隐静脉与对角支及钝缘支搭蛇形桥1例。1例同时行心肌激光打孔术。结果:无手术死亡,无手术并发症。平均手术时间3小时,平均术后呼吸机辅助时间9.2±5.9小时。其中10例(76.9%)患者未输血。平均住院费用3.50±0.95万元。4例患者平均随诊6.5±3.3个月,心绞痛消失,2例患者超高速计算机断层摄影术或核磁共振成像检查示冠状动脉旁路通畅。结论:微创CABG安全可靠,创伤小,早期结果满意。与体外循环下的CABG相比可以减少输血,降低医疗费用,减少手术并发症的发生。 相似文献
2.
急性心肌梗塞直接经皮冠状动脉腔内成形术 总被引:36,自引:2,他引:34
目的观察急性心肌梗塞(AMI)患者应用直接经皮冠状动脉腔内成形术(PTCA)的安全性和有效性。方法对114例AMI患者在发病12小时内行直接PTCA术,其中有5例心原性休克的患者。梗塞相关血管(共115支血管):左主干3例(2.6%),前降支56例(48.7%),回旋支12例(104%),右冠状动脉44例(38.5%)。TIMI血流:0级82例(71.3%),1级17例(14.7%),2级16例(14.0%)。结果111例患者手术成功,TIMI血流3级(97.4%)。住院期间死亡3例(2.6%),均为心原性休克患者,其中2例经紧急冠状动脉旁路移植术后死亡。85例患者置入了冠状动脉内支架(73.9%)。随访95例患者,2例后期死于心力衰竭,9例出院后出现心肌缺血,其中8例再次行PTCA术。结论直接PTCA是治疗急性心肌梗塞的安全有效措施,成功率较高,并发症少;术后复发心肌缺血发生率较溶栓治疗低。 相似文献
3.
冠状动脉内支架植入术治疗急性心肌梗死的临床应用 总被引:1,自引:0,他引:1
目的:评价冠状动脉内支架治疗急性心肌梗死(AMI)的效果。方法:对48例植入支架的AMI连续病例进行回顾性分析。结果:心肌梗死相关血管为:前降支33例,右冠状动脉8例,回旋支4例,左主干1例以及大隐静脉桥2例。48例患者共植入57只支架,其中34例因球囊扩张后结果不理想,12例因非闭塞性夹层,2例因闭塞性夹层。支架植入成功率为938%,术后残余狭窄降至(24±71)%。院内严重并发症3例,其中1例(21%)死亡,2例(42%)行急诊冠状动脉旁路移植术。对无院内并发症的45例患者随访10.1±72个月,其中3例失访,出院后2例发生再狭窄和1例有慢性充血性心力衰竭,无其它心脏事件发生。结论:本研究结果表明AMI时冠状动脉内植入支架成功率高,并发症少,短期预后良好 相似文献
4.
冠状动脉重建术后氧输送和氧耗关系的探讨 总被引:1,自引:0,他引:1
观察30例冠状动脉旁路移植术(CABG)后氧输送指数(DO2I)、氧耗指数(VO2I)及其关系。其中单纯CABG15例,伴左室室壁瘤切除12例,心脏瓣膜替换3例。全组架1~4支桥者分别是10、8、8、4例。结果29例成活,1例死亡。成活组术后即刻至3小时DO2I提高10.6%(P<0.05)。VO2I增高15.8%(P<0.01).术后14小时较6小时DO2I增加15.8%(P<0.01),而VO2I降低4.4%。死亡例即刻至3小时DO2I增加6.0%,VO2I却降低29.1%,死于多器官功能衰竭。资料表明,作为CABG术后正常恢复经过,早期DO2I升高的同时VO2I也升高,此时,细胞内氧化磷酸化得到改善,氧债得到清偿。氧输送和氧耗达到平衡后VO2I不再增加。可见CABG术后维持满意DO2I非常重要。 相似文献
5.
右室梗塞冠脉阻塞部位与血流动力学异常程度关系的探讨 总被引:10,自引:0,他引:10
为了解右室梗塞冠脉阻塞部位与血流动力学的关系,对21例急性下壁心肌梗塞患者进行血流动力学监测和冠状动脉造影发现,血流动力学改变符合急性右室梗塞(RVMI)16例,无RVMI5例。16例中15例(93.8%)为右冠状动脉(右冠脉)近或中段阻塞,1例(6.2%)为左回旋支阻塞,无冠脉远段的阻塞。同时发现,血流动力学紊乱较重[平均右房压(MRAP)/肺毛细血管楔入压(PCWP)≥0.8]和较轻(MRAP/PCWP0.65~<0.8)两亚组右冠脉近、中段阻塞分别为10例中的4例、5例、6例中的3例和3例。结果表明,下壁心肌梗塞病人中右冠脉近或中段阻塞可导致RVMI,并且RVMI时血流动力学紊乱程度与冠脉阻塞部位不一致。 相似文献
6.
冠心病合并左心功能不全患者冠状动脉旁路移植术效果 总被引:5,自引:0,他引:5
胡盛寿 《中华心血管病杂志》1999,(1):26-28
总结151例左室射血分数(LVEF)<45%患者的冠状动脉旁路移植术(CABG)效果。方法单纯CABG组61例,平均LVEF(40.8±3.7)%,平均塔桥3.6支;CABG合并其它手术组90例,平均LVEF(34.4±7.1)%,平均搭桥1.8支,合并手术包括室壁瘤切除或成形87例,瓣膜置换3例。结果两组分别死亡2例和6例,心律失常和术后低心排是手术死亡的主要原因。平均随访34个月,随访率为92%,两组各死亡2例,其中3例与心脏因素有关。两组LVEF分别为(55.6±7.3)%和(50.4±11.4)%,较术前有明显提高(P<0.01)。术前心绞痛症状基本消失。早晚期病死率没有明显差异(P>0.05)。结论CABG对伴有左心功能不全的冠心病患者是一种安全有效的治疗方法。移植血管应尽可能应用乳内动脉,以提高远期效果。加强围术期的处理,调整心脏的前后负荷,兼顾心肌氧需和氧耗平衡,必要时应用主动脉内球囊反搏或左室辅助(LVAD),以提高手术效果。 相似文献
7.
经皮冠状动脉腔内成形术229例长期预后分析 总被引:4,自引:0,他引:4
为了探讨国人经皮冠状动脉腔内成形术(PTCA)后远期疗效及影响疗效的因素,对PTCA成功的229例患者用门诊随诊或信访方式进行随访,随访时间0.5~8.4(平均2.3±1.8)年。结果显示:76例(33.2%)患者心绞痛症状复发,随访期中死亡2例(0.9%),非致命性急性心肌梗塞6例(2.6%),行冠状动脉旁路移植术4例(1.7%),重复PTCA29例(12.7%)。以Kaplan-Meier法计算术后无心脏事件生存率,1年为84.8%,8年为70.5%。Cox回归分析表明,术前病变狭窄程度及术后前降支残余狭窄程度与发生心脏事件的相对危险性呈正相关。提示国人PTCA可取得较好远期疗效;术中尽可能减少前降支残余狭窄,可能减少心脏事件发生的相对危险度 相似文献
8.
冠状动脉旁路移植术16例临床分析 总被引:1,自引:0,他引:1
回顾分析1986年7月至1993年2月间16例冠状动脉旁路移植术的资料。诊断为不稳定型心绞痛15例,急性心肌梗塞并室间隔破裂1例。择期手术14例,紧急手术2例。搭桥总数为34支,平均每例2.1支,2例应用了乳内动脉移植。合并手术有动脉内膜切除术(2例)、双瓣膜替换术(1例)和室间隔修补术(1例)。择期手术早期死亡1例(7.1%),紧急手术2例均死亡,死亡原因均为严重低心输出量综合征。随访3个月至7年,1例仍有症状,其余患者显著改善,生存良好。就冠状动脉旁路移植术的病例选择、血管重建与术前术后处理原则、紧急手术和联合手术等问题进行了讨论。 相似文献
9.
急性心肌梗塞恢复期的冠状动脉内支架置入术 总被引:10,自引:0,他引:10
16例急性心肌梗(AMI)患者发病后恢复期(2~4周)行及冠状动脉内支架术治疗。分为两组,梗塞后心绞痛组6例,梗塞后心功能不全组10例。经冠脉造影证实其梗塞相关冠状动脉均处于完全闭塞及次全闭塞状态。15例为单支,1例为双支。术前平均狭窄度(92.5±5.1)%,平均狭窄长度(19.5±5.3)mm。共植入19枚支架。手术成功率100%,1例术后3天发生亚急性血栓形成。术后造影显示平均狭窄度为0~10%,梗塞后心绞痛组临床症状消失,梗塞后心功能不全组的超声心动图提示左房内径(36.8±3.4)mm,左室内径(55.10±3.73)mm,左室射血分数0.61±0.08,优于术前的左房内径(39.40±4.12)mm,左室内径(59.60±5.25)mm,左室射血分数0.52±0.10。随访1~20个月无1例死亡,无再梗塞,心功能均在Ⅰ~Ⅱ级。本文说明AMI恢复期冠脉再通是增加冠脉血流,维持正常心功能和降低死亡率的一个有效方法。 相似文献
10.
冠状动脉内支架植入术在冠心病治疗中的应用 总被引:17,自引:0,他引:17
报道68例冠心病患者80支血管病变植入118个支架,植入成功率为92.1%。其中不稳定心绞痛者占50%,既往有心肌梗塞史者占46%,多支病变者占62.4%,B2型以上病变占66.6%,因PTCA术后不良结果而植入支架的病变占27.5%(22/80),因术后急性并发症者17.5%(14/80),Denovo病变占55%(44/80)。狭窄程度由术前的85.5%±12.9%减至术后的5.8%±11.4%。术后4周~1年间,60例患者(88.2%)症状缓解,6例(8.8%)心绞痛复发,其中4例(5.8%)经冠状动脉造影证实支架部位再狭窄,术后2个月内死亡2例(2.9%),术后1周内发生无Q波心肌梗塞者1例 相似文献
11.
目的:介绍全动脉化冠状动脉旁路移植(CABG)的早期效果和经验。方法:74例全动脉化CABG的患者。74例患者分别在体外循环(CPB)和非CPB下行CABG。应用左乳内动脉(IMA)1例,左IMA加单挠动脉(RA)14例,左IMA加双RA 54例,双IMA加双RA 3例,双RA 2例。人均搭桥4.7(17)支,序贯吻合66例,“Y”和“T”型吻合分别为15和6例。结果:围手术期无死亡。本组患者随访518(平均12.2)个月,均恢复良好,无心绞痛症状再发。多普勒和16排CT示血管桥无狭窄通畅。结论:全动脉化CABG取得好的早期效果,是一种值得积极推广的方法。 相似文献
12.
目的:探讨全动脉化冠状动脉旁路移植术的手术技术。 方法:42例接受全动脉化冠状动脉旁路移植术的患者,其中男性37例,女性5例,年龄28~73岁,平均(57.43±7.45)岁。体外循环下搭桥16例,非体外循环下心脏不停跳搭桥26例。人均旁路3.08支(1~5支),左乳内动脉(IMA)34例,双侧IMA 8例,左侧桡动脉(RA)33例,双侧RA 9例,胃网膜右动脉(GEA)1例。 结果:术后仅1例患者因多器官功能衰竭死亡(死亡率2.4%),41例(97.6%)症状明显改善,康复出院。 结论:全动脉化搭桥手术早期临床效果满意。 相似文献
13.
为了探索国人应用乳内动脉做冠状动脉旁路移植术的近期临床效果,从94年10月至98年3月共60例冠心病人采用乳内动脉、桡动脉及大隐静脉做冠状动脉旁路移植术(CABG).大多数为三支病变及左主干病变.中低温及常温体外循环,经主动脉根部间断灌注冷血或温血停跳液心肌保护.强调在取乳内动脉时要格外小心,不要用器械钳夹乳内动脉,牵拉应轻柔.采用8-0 Prolene线做乳内动脉与前降支等做远端吻合.吻合完成后应将乳内蒂固定于心脏表面,减少吻合口张力.最后切开左上心包让乳内动脉走行平坦,无张力.平均搭桥支数为3.5根.术后死亡1例,死亡率1.7%.使用乳内动脉做CABC是安全有效的.59例病人心绞痛完全缓解,活动能力及生活质量明显提高. 相似文献
14.
目的总结左主干重度狭窄冠心病患者行非体外循环下冠状动脉旁路移植术(OPCAB)的治疗效果和临床经验。方法回顾分析2005年1月至2012年6月,83例左主干狭窄〉70%的患者接受了非体外循环下冠状动脉旁路移植术,其中27例急诊手术,三支病变62例,两支病变21例,术中改为体外循环5例;使用主动脉内球囊反搏7例。结果远端吻合口平均(3.34±0.83)个,死亡2例(2.4%)。随访2个月至2年,仅1例心绞痛复发,余者均未出现心绞痛症状。手术效果及手术并发症的发生与非左主干病变组差异无统计学意义(P〉0.05)。结论左主干重度狭窄行非体外循环下冠状动脉旁路移植术临床效果良好。 相似文献
15.
BACKGROUND: Bilateral internal mammary artery (IMA) grafting is associated with an improved long-term survival, low rates of recurrence of angina and late myocardial infarction. However, because of the inadequate length of the conduit, use of bilateral internal thoracic artery grafting occasionally is not suitable for complete revascularization. To overcome this limitation, extra length can be obtained by skeletonization of both IMAs. We decided to prospectively assess the safety of this technique. METHODS: One hundred patients with a mean age of 52.5 +/- 13.1 years underwent complete revascularization with skeletonized bilateral internal mammary arteries on cardiopulmonary bypass (CPB). The right internal mammary artery (RIMA) was used as a free graft connected to the in situ left IMA (LIMA) in 88 patients. A free LIMA was attached to in situ RIMA in 12 patients. The average number of grafts was 3.2 per patient (range: 2-4 grafts per patient). Mean left ventricular ejection fraction was 60% (range: 25-80%). RESULTS: No patient required reexploration for bleeding, and no patient died within 30 days after operation. On the basis of electrocardiographic changes, three patients sustained a perioperative myocardial infarction. One patient had a sternal wound infection. Mean follow-up was 24 months (range: 6-36 months). The actuarial survival rate was 99 +/- 1% at 3 years. No myocardial infarctions were reported during the follow-up. Three patients had recurrent angina with conduit occlusion diagnosed on coronary angiography. CONCLUSION: Complete myocardial revascularization with skeletonized bilateral internal mammary arteries is a safe and reliable technique with excellent early and mid-term results. 相似文献
16.
BACKGROUND. Saphenous vein grafts (SVG) and internal mammary artery (IMA) grafts have been used for coronary artery bypass grafting. In adult patients with bypass grafting for atherosclerotic coronary artery disease, IMA grafts have been reported to have long-term patency; however, results are conflicting on whether the graft is sufficient to meet increased myocardial oxygen demand during exercise. There have been no studies on hemodynamics and blood flow during exercise after bypass grafting with IMA in pediatric patients with Kawasaki disease. METHODS AND RESULTS. We studied 17 pediatric patients with Kawasaki disease (average age, 7.5 +/- 3.1 years), who underwent coronary artery bypass grafting with the IMA. The average number of coronary artery bypass grafts was 2.1 +/- 0.7/patient. For all patients, the left IMA was anastomosed to the left anterior descending coronary artery; for eight patients, the right IMA was also anastomosed to the right coronary artery. In addition, 11 SVGs were used. The postoperative patency rates after 1 month were 100% with the IMA graft and 91% with SVG. One year after the operation, the patency rates were 100% with IMA and 50% with SVG. Hemodynamics during exercise were measured with a bicycle ergometer, and coronary sinus blood flow was measured by the continuous thermodilution method in six patients. The relation between delta LVEDP (the difference between left ventricular end-diastolic pressure at rest and during exercise) and delta SVI (the difference between the stroke volume index at rest and during exercise) was analyzed. Four of six patients had reduced cardiac function before operation (delta LVEDP, positive; delta SVI, negative). However, after the operation, all patients demonstrated improvements in cardiac function during exercise (delta LVEDP, positive; delta SVI, positive). Coronary sinus flow per left ventricular mass increased after operation from 70 +/- 46 to 87 +/- 56 ml/min at rest (p less than 0.05) and from 139 +/- 118 to 183 +/- 150 ml/min during exercise (p less than 0.05). CONCLUSIONS. In conclusion, this study reveals improvements in both hemodynamics and coronary blood flow during exercise after coronary artery bypass grafting with IMA grafts in pediatric patients with Kawasaki disease. 相似文献
17.
目的:评估不停跳冠状动脉旁路移植术中,分别采用侧侧吻合与端侧吻合方式缝合大隐静脉序贯桥终末端与细小靶冠状动脉的疗效。方法:回顾性分析2012年10月至2013年4月,行不停跳冠状动脉旁路移植术且终末靶冠状动脉细小的患者共89例。其中37例患者使用侧侧吻合术,即采用侧侧吻合方法缝合大隐静脉序贯桥终末端与靶冠状动脉;52例患者使用端侧吻合术,即将大隐静脉序贯桥终末端与靶冠状动脉进行端侧吻合。术中监测桥血管流量及搏动指数,术后6个月复查超声心动图、心电图等指标,以评估手术疗效。术后1年行双源CT冠状动脉造影检查,观察终末桥血管的通畅情况。结果:两组术中终末桥血管流量分别为[(17.32±6.18)vs.(14.15±5.09)mL/min,P0.05],搏动指数分别为[(2.50±1.08)vs.(3.47±0.74),P0.05]。两组患者在围术期内均无低心排出量综合征(低心排)、恶性心律失常及心肌梗死等不良事件发生。术后6个月复查超声心动图,提示两组患者心功能均较术前改善,但两组之间差异无统计学意义(P0.05)。术后随访1年时侧侧吻合组患者均无心绞痛发作,端侧吻合组有9例患者再发心绞痛。双源CT冠状动脉造影提示:侧侧吻合组中终末桥血管均保持通畅,而端侧吻合组中8例患者的终末桥血管再狭窄(P0.05)。随访截至2014年1月底,平均随访时间为(10.7±2.5)个月,患者随访率为100%,存活率为100%。结论:采用侧侧吻合术缝合大隐静脉序贯桥终末端与细小靶冠状动脉,可改善终末桥血管的通畅性。 相似文献
18.
冠状动脉搭桥围术期急性心肌梗死紧急再搭桥 总被引:4,自引:0,他引:4
目的:回顾性分析冠状动脉搭桥围术期急性心肌梗死急诊再搭桥的临床经验。方法:在510例冠状动脉搭桥患中,5例患在术后4h内因急性心肌梗死需急诊再搭桥,发生率0.98%。5例患中,男女比例为4:1,年龄56-77岁(平均63.6岁),均为冠状动脉三支血管病变(3例伴左主干病变),手术中搭桥3-5支(人均搭桥3.6支),左乳内动脉桥5根,其余为大隐静脉桥。2例在关胸后20min,3例在回重症监护病房后2-4h出现急性心肌缺血表现(明显心电图ST-T变化),伴室颤2例,5例血液动力学均不稳定,药物处理难以稳定血液动力学。全部患均立即送手术室(2例仍在手术室),急诊再次开胸。探查发现,2例患静脉桥(分别搭桥到回旋支第二钝缘支和右冠状动脉后降支)内急性血栓形成;另3例所有静脉桥良好,但左室前壁收缩运动明显减弱,结合心电图变化,诊断为左乳内动脉灌注不良。重新建立体外循环,清除桥内血栓重新搭桥2例(1例在非体外循环心脏跳动下进行);另取一段静脉搭桥到左乳内动脉-左前降支吻合口远端的左前降支3例。结果:5例患顺利度过手术,均置入主动脉内球囊反搏,支持22-25h(平均42h)。手术后呼吸机支持4h-18d(平均7.3d)合并消化道出血4例,肾功能不全2例,肺部感染2例,切口感染1例。手术后住院时间12-35d,平均21d。全组均痊愈出院。结论:冠状动脉搭桥围术期急性心肌梗死应重在预防。如怀疑桥有问题,急诊再搭桥是良好选择,但手术后并发症发生率明显增加。 相似文献
19.
Goldman S Zadina K Moritz T Ovitt T Sethi G Copeland JG Thottapurathu L Krasnicka B Ellis N Anderson RJ Henderson W;VA Cooperative Study Group #// 《Journal of the American College of Cardiology》2004,44(11):2149-2156
OBJECTIVES: This study defined long-term patency of saphenous vein grafts (SVG) and internal mammary artery (IMA) grafts. BACKGROUND: This VA Cooperative Studies Trial defined 10-year SVG patency in 1,074 patients and left IMA patency in 457 patients undergoing coronary artery bypass grafting (CABG). METHODS: Patients underwent cardiac catheterizations at 1 week and 1, 3, 6, and 10 years after CABG. RESULTS: Patency at 10 years was 61% for SVGs compared with 85% for IMA grafts (p < 0.001). If a SVG or IMA graft was patent at 1 week, that graft had a 68% and 88% chance, respectively, of being patent at 10 years. The SVG patency to the left anterior descending artery (LAD) (69%) was better (p < 0.001) than to the right coronary artery (56%), or circumflex (58%). Recipient vessel size was a significant predictor of graft patency, in vessels >2.0 mm in diameter SVG patency was 88% versus 55% in vessels =2.0 mm (p < 0.001). Other positive significant predictors of graft patency were use of aspirin after bypass, older age, lower serum cholesterol, and lowest Canadian Functional Class (p < 0.001 to 0.058). CONCLUSIONS: The 10-year patency of IMA grafts is better than SVGs. The 10-year patency for SVGs is better and the 10-year patency for IMA grafts is worse than expected. The 10-year patency of SVGs to the LAD is better than that to the right or circumflex. The best long-term predictors of SVG graft patency are grafting into the LAD and grafting into a vessel that is >2.0 mm in diameter. 相似文献
20.
Stephen T. Crowley Roger D. Bies Douglass A. Morrison Charles C. Barbiere 《Catheterization and cardiovascular interventions》1996,38(3):256-262
Angioplasty of the internal mammary artery (IMA) bypass graft has been shown to be a safe and effective revascularization procedure. However, angiographic and long term clinical outcomes in the high-risk group of patients presenting with rest angina has not been well documented. We report the results of IMA angioplasty in 20 patients with rest angina out of 614 (3.2%) who received a left IMA graft at our institution between April 1987 and September 1994. All patients were admitted with rest angina, 12 patients demonstrated persistent ischemia despite medical therapy, two patients were in heart failure, and one patient was in cardiogenic shock. Balloon angioplasty was successful in 15 of 20 patients (75%). Failed angioplasty was associated with either severe IMA tortuousity (three patients) or inability to cross the anastomotic stenosis with the guide wire (two patients). Each of these five patients required angioplasty of either the native left anterior descending artery or other saphenous vein grafts for clinical stabilization. No patient suffered a major complication (myocardial infarction, emergent coronary bypass surgery, death). Clinical follow-up was obtained in all 20 patients (6 months, 7 years, mean 27 months). Twelve patients (60%) were asymptomatic or had stable angina at follow-up, and 8 returned with anginal symptoms. Four patients required repeat angioplasty for disease in other vessels, two were treated medically for angina, one underwent repeat CABG, and cardiac transplantation was performed in one patient for refractory heart failure. Angiographic follow up was obtained in 10/15 (66%) successful angioplasty patients, and only one patient demonstrated restenosis at the treated site (10%). During follow up one patient developed an IMA stenosis at a previous dissection site in the body of the graft that was treated with angioplasty. These results suggest that IMA angioplasty in patients with rest angina is associated with excellent long term patency and clinical efficacy, as well as low procedural risk. © 1996 Wiley-Liss, Inc. 相似文献