冠状动脉旁路移植术后心房颤动的相关危险因素研究

目的研究冠状动脉旁路移植术（CABG）后心房颤动（AF）的相关危险因素。方法回顾性分析我院427例冠状动脉旁路移植术患者的病例资料,并根据术后是否发生房颤分为AF组和非AF组。比较两组资料,进行统计分析,筛选高危因素。结果本组CABG术后心房颤动发生率为21．31％。单因素分析,年龄、吸烟史、高血压史、P波离散度、RCA近中段狭窄〉50％、左心房内径（LAD）、左室射血分数（LVEF）、采用体外循环与否、同期行瓣膜手术与否、移植血管数目差异均具有统计学意义。多因素logistic回归分析提示,年龄〉65岁、P波离散度〉40s、RCA近中段狭窄〉50％、LAD〉40mm、LVEF≤40％均与术后房颤发生有显著相关性。结论年龄〉65岁、P波离散度〉40s、RCA近中段狭窄〉50％、LAD〉40mm、LVEF≤40％是CABG术I暑皂鲕倍士的倍除隅壹     

冠状动脉旁路移植术后低氧血症危险因素研究

目的 分析冠状动脉旁路移植术后低氧血症发生的危险因素,探讨其预防和治疗方法.方法 回顾性分析我院198例冠状动脉旁路移植术（CABG）患者,男性140例,女性58例,年龄40～84（66.36±9.29）岁.机械通气（FiO2＞45％）或面罩给氧（氧流量＞6 L/min）,术后PaO2低于[102-（0.33×年龄）]mm Hg者,确诊为低氧血症,对其术前、术中、术后相关因素进行单因素及多因素回归分析.结果 术后低氧64例,低氧发生率32.3％,成功纠正低氧60例,余4例出现多器官功能衰竭死亡,纠治率93.8％.术前、术中、术后单因素分析有统计学意义的因素包括吸烟史、糖尿病病史、术后胸腔积液、术后肺部感染、呼吸机辅助通气时间、血管病变根数、术后24h引流量、RBC输注量、术中液体入量、手术时间、主动脉阻断时间、体外循环时间和术前PaO2.多因素回归分析CABG术后低氧血症的独立危险因素有：术后肺部感染（OR=10.906,95％CI3.082～38.592）、血管病变支数（OR=3.432,95％CI 1.552～7.590）、吸烟史（OR =2.385,95％CI 1.181～4.815）、糖尿病史（OR=2.542,95％CI1.253～5.157）,预测强度依次递减（P＜0.05）.结论 充分认识CABG术后低氧血症的危险因素,合理的围术期处理可有效防治CABG术后低氧.     

70岁以上女性冠心病患者非体外循环冠状动脉旁路移植术

目的　分析总结 5 2例 70岁以上女性冠心病患者非体外循环冠状动脉旁路移植术。方法　 2 0 0 0年 8月至2 0 0 3年 9月共完成 5 2例 70岁以上女性冠心病患者非体外循环冠状动脉旁路移植术 ,平均年龄 (71.4± 1.7)岁。本组病例 ,不稳定型心绞痛 2 7例 ,1个月内急性心肌梗死 7例。冠状动脉 3支血管病变 4 7例 ,左主干病变 10例。 9例左心室射血分数低于 30 % ,10例左心室舒张期末内径大于 6 0 mm。结果　完成非体外循环冠状动脉旁路移植术 5 0例 ,包括急症手术 3例。 2例改为体外循环冠状动脉旁路移植术。平均远端血管吻合数 (2 .9± 1.2 )例。 4例使用主动脉气囊反搏。 1例术后 3周死于胸骨后感染所致多脏器功能衰竭。结论　非体外循环冠状动脉旁路移植术对 70岁以上女性患者是安全可行的。     

189例重症冠心病的冠状动脉旁路移植术临床分析

目的:提高重症冠心病人冠状动脉旁路移植术的手术疗效。方法:回顾性分析189例重症冠心病的冠状动脉旁路移植术资料。其中应用体外循环157例,非体外循环32例;搭桥数1～6(平均3.49±1.04)支/人。对手术方法、主要并发症和术后处理进行分析总结。结果:二次开胸4例(2.1％),低心排综合征9例(4.8％),应用主动脉内球囊反搏(IABP)4例(2.1％),反复发作房颤17例(9.0％),胸腔积液27例(14.3％),肺功能不全6例(3.2％),脑合并症3例(1.6％),肝功能不全5例(2.6％),肾功能不全6例(3.2％),死亡7例(3.7％),其余病人康复出院。结论:合理的选择病人,成熟的手术技术,良好的心肌保护,停机困难者IABP的尽早应用及术后处理的加强是提高重症冠心病人冠状动脉旁路移植术疗效的重要措施。     

冠状动脉搭桥术移植材料的选择

目的总结选择冠状动脉搭桥术移植材料的经验和体会。方法自2001年4月至2004年4月,我们选用乳内动脉、桡动脉和大隐静脉共90例冠心病患者行冠状动脉搭桥术。本组患者男性74例,女性16例,年龄48～74岁。心功能Ⅱ～Ⅳ级,单支血管病变6例,双支血管病变20例,三支血管病变64例。合并高血压30例,陈旧性心梗18例,慢性肺阻塞性通气障碍14例,糖尿病18例,室壁瘤3例,急性心梗2例。选用乳内动脉搭桥88支,桡动脉搭桥84支,大隐静脉搭桥109支。结果无死亡病例,全部痊愈出院。术后发生切口感染4例,胸骨裂开3例,胸腔积液8例,肺炎肺不张12例,心律失常15例。随访6～36个月,心电图检查无新的缺血和梗死表现,生活质量均有明显提高。结论正确的选择移植材料是提高血管桥通畅率、保证手术效果的关键措施。移植材料的选择应根据患者的全身情况和术者的技术水平决定。     

Coronary artery size as a predictor of Y-graft patency following coronary artery bypass surgery

This study aims to evaluate the association between target vessel size and graft patency in the right IMA–right coronary territory anastomosis.A total of 402 patients who underwent CABG between 2005 and 2016 using the right IMA Y-graft to the posterolateral branch or posterior descending artery were enrolled. Preoperative coronary angiography was utilized to measure the size of the target coronary arteries in the right territory. Follow-up angiography and computed tomography at 6 to 12 months were used to determine graft patency.Thirty patients (7.5%) were found to have occluded graft. Larger target vessel size was associated with lower risk of graft occlusion (OR: 0.18, 95% CI:0.05–0.62, P = .007). The receiver operating characteristic (ROC) curve showed that the cutoff-value of 1.93 mm was found to have the maximum sum of sensitivity and specificity for graft patency (Area under the curve (AUC): 0.65, P = .01). Excluding patients with right coronary artery total occlusion, the discriminative performance of target vessel size became more prominent (AUC: 0.76, P < .01), with same cutoff value.In the setting of bilateral IMA composite grafting, the patency of right IMA to right coronary territory was influenced by the size of the target coronary artery. The influence of target coronary artery size was prominent in non-total occlusion patients. Careful selection of a target anastomosis site is recommended.     

Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft

Objectives To evaluate the outcome of off-pump coronary artery bypass grafting (OPCABG) using a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients (196 males and 12 females) underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33–78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries (IMAs), and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery (LIMA) in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intra-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5 ± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions.     

冠状动脉旁路移植术后胸部切口感染的治疗

目的探讨冠状动脉旁路移植术后胸部切口感染的原因和治疗。方法分析321例冠状动脉旁路移植术后24例胸部切口感染患者行二期清创缝合或二次手术资料。结果本组24例患者均一期愈合，痊愈出院，随访1—96个月，无胸部切口相关并发症。结论冠状动脉旁路移植术后胸部切口感染的原因是多方面的，行二期清创缝合或二次手术，可获良好效果。     

冠状动脉旁路移植术治疗冠心病的体会

目的 探讨冠状动脉旁路移植术（CABG）对冠心病的治疗效果.方法 2005年7月至2010年 8月共行冠状动脉旁路移植术 82例,年龄38～78（61.8±12.7）岁,病程3个月至12年;有心肌梗死病史13例（15.6%）,合并高血压56例（68.3%）、糖尿病30例（36.5%）.术前心功能（NYHA）Ⅰ～Ⅲ级,Ⅰ级21例、Ⅱ级48例、Ⅲ级13例.手术在全麻体外循环下进行,取大隐静脉（SVG）与左乳内动脉（LIMA）,左乳内动脉与前降支（LAD）搭桥,其余用大隐静脉搭桥,平均每例搭桥（2.60±0.85）根,二尖瓣成形4例.结果 全组死亡1例,死于急性胰腺炎.术后低心排6例、房颤 10例,并发肺不张2例,4例术后引流多,二次开胸止血,1例术后第3天发现上纵隔增宽,二次开胸清除血块.结论 冠状动脉旁路移植术疗效显著,确切恢复和重建心肌血运,手术安全,结果令人满意.     

冠状动脉旁路移植术后院内传导阻滞的临床分析

目的 分析冠状动脉旁路移植术(CABG)后住院期间传导阻滞发生及转归的相关因素.方法 将2005年1月至2006年12月在我院行单纯CABG的649例患者按照术前合并传导阻滞情况分为3组:无传导阻滞组(N组)586例,高位传导阻滞组(A组)27例,低位传导阻滞组(B组)36例.记录围手术期各项指标及术中旁路重建情况.结果 N组术后住院期间8.02%发生高位传导阻滞,8.7%发生低位传导阻滞;出院时4.61%仍合并传导阻滞.A组术后住院期间59.21%仍为高位传导阻滞,3.7%出现低位传导阻滞;出院时29.63%仍合并传导阻滞.B组术后住院期间至出院时86.11%仍为传导阻滞.结论 CABG术后新发传导阻滞大多数为可恢复性,高龄可能是术后新发高位传导阻滞的高危因素,而术前心脏结构、功能,冠脉病变程度以及术中心肌损伤,可能与术后新发低位传导阻滞相关.术前合并高位传导阻滞患者在术后多数可以恢复正常,可能与年龄和术前应用药物有关.术前合并低位传导阻滞患者在术后仅有少部分可能恢复正常,采用off-pump手术、减少术中心肌损伤可能是其相关因素.     

老年冠心病患者非体外循环冠状动脉搭桥术25例

目的 总结25例老年（≥70岁）冠心病患者非体外循环冠状动脉搭桥术（OPCABG）的临床体会.方法 回顾性分析我院2007年7月至2013年11月经OPCABG治疗的25例老年冠心病患者的临床资料.结果 全组手术均获成功.无手术死亡,无中转体外循环完成手术者,围手术期死亡率0,无围手术期心肌梗死及神经系统并发症.全组应用左乳内动脉（IMA）和大隐静脉（SVG）搭桥77支,平均（3.1±1.0）支,行左乳内动脉与前降支吻合20例（80％）,大隐静脉搭桥24例（96％）,共57支,包括左乳内动脉（IMA）和大隐静脉（SVG）搭桥19例（79％）41支,完全静脉桥5例（20％）16支,其中序贯静脉桥14例（56％）18支.术后低心排综合征3例,应用IABP 1例,术后出现肺部并发症5例,呼吸衰竭2例,开胸止血1例,伤口感染1例.不稳定型心绞痛者,除2例术后无缓解,后经PTCA治疗有所缓解外,大部分手术后完全缓解.心功能不全者术后逐渐得到纠正,心功能Ⅰ～Ⅱ级.术后随访3～60个月,随访期间除1例死于心肌再梗死,1例死于肝癌外,大部分患者生活质量明显改善.结论 老年冠心病患者行OPCABG是一种安全、有效的方法,特别是对一些左主干病变、三支病变、合并心功能及其他重要脏器功能不全患者是一种更具优势的方法.     

自体桡动脉在冠状动脉旁路移植术中的应用

探讨 2 8例桡动脉 ( RA )应用于冠状动脉旁路移植术的手术技术和临床经验。2 8例中 ,男 2 6例 ,女 2例 ;年龄 3 8～ 73岁 ,平均 ( 5 3 .3 2± 8.72 )岁 ;体外循环下搭桥 6例 ,非体外循环下搭桥 2 2例 ( 75 .7% ) ;全动脉化搭桥 2 4例 ( 85 .7% ) ,双侧 RA9例 ,左侧乳内动脉 ( IMA) 2 8例 ,双侧 IMA7例 ,胃网膜右动脉 1例。人均搭桥3 .15支 ( 2～ 5支 ) ,序贯吻合 5例 ,“Y”型吻合 2例 ,室壁瘤切除 ,左心室几何成形术 1例。2 7例顺利康复 ( 96.4% ) ,因多器官功能衰竭死亡 1例 ( 3 .6% )。认为自体 RA是理想的第二种动脉移植物 ,远期通畅率高 ,适合于各种冠状动脉搭桥术     

Hiatal hernia after robotic-assisted coronary artery bypass graft surgery

BackgroundThe aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery.MethodsWe reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH.ResultsWe found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4–9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2–64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10–8.43), P=0.033.ConclusionsRA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.     

186例老年冠心病患者是、否体外循环下冠脉旁路移植术的比较

目的:比较老年冠心病患者体外循环与非体外循环下冠状动脉旁路移植术的疗效。方法:A组选择87例65岁以上的老年患者在体外循环下行冠状动脉旁路移植术(CCABG);B组选择79例65岁以上的老年患者在非体外循环下行冠状动脉旁路移植术(OPCABG)。结果:B组死亡率低于A组(P<0.05),术后胸腔引流量明显少于A组(P<0.05)。结论:老年冠心病患者行冠状动脉旁路移植术是安全的。     

可达龙治疗冠状动脉旁路移植术后快速性心律失常的疗效观察

目的评价可达龙（盐酸胺碘酮）对非体外循环下冠状动脉旁路移植术（OPCAB）后快速性心律失常的疗效。方法可达龙静脉负荷量150mg（3～5mg／kg）于10min内注射，如有效，继续以1．0mg／min静脉泵入；6h后改为0．5mg／min维持。若首剂静脉注射后20min疗效不明显，可再次静脉注射75～150mg，然后静脉泵入维持。总量〈1200mg／d。为保持疗效，可于静脉用药第1天加用或改用口服。结果本组110例中，快速心房颤动59例，显效50例；室上性心动过速30例，显效25例；房扑12例，显效8例，总有效98例，有效率89．1％。结论可达龙为治疗OPCAB后快速性心律失常的有效药物，安全可靠，疗效肯定，不良反应少。     

Off-pump coronary artery bypass grafting in India

Off-pump Coronary Artery Bypass Grafting (OPCAB) is the latest innovation in cardiac surgery. However OPCAB is not adopted universally. Even there have been suggestions of abandoning OPCAB in a special report. In India, OPCAB has been successfully adopted across the board. There are various evidences which favor OPCAB and are discussed in this review. The purpose of this review is to put forward the perspective of the OPCAB surgeons of our country and critically look at the suggestion of abandoning OPCAB.     

非体外循环冠状动脉旁路移植术后疗效观察

目的通过与传统体外循环冠状动脉旁路移植术（CCABG）对比,评价非体外循环冠状动脉旁路移植术（OPCAB）的近期临床疗效。方法纳入36例冠状动脉粥样硬化性心脏病患者,随机分为CCABG组（n=15）和OPCAB组（n=21）,记录两种方法的桥血管数、住院期间死亡率、手术和住院时间、引流量、血肌酐等近期临床指标。结果与CCABG相比,OPCAB的桥血管数、住院期间死亡率无统计学差异（P〉0.05）,但手术时间缩短[（183.65±52.71）min vs.（273.32±36.53）min]、住院时间缩短[（8.60±1.38）d vs.（14.30±3.18）d]、24h引流量明显减少[（278.31±138.50）ml vs.（473.84±121.76）ml]、血肌酐明显下降[（105.65±19.42）mmol/L vs.（139.41±38.61）mmol/L]。结论与CCABG相比,OPCAB治疗冠心病安全可行,临床疗效较好。     

Right heart bypass for left circumflex coronary artery bypass grafting

Displacement of the heart to expose the left circumflex artery (LCX) causes hemodynamic disturbance during off-pump coronary artery bypass grafting (CABG). We applied right heart bypass (RHB) using a heparin-coated centrifugal pump without an oxygenator in an attempt to stabilize the hemodynamics. Five mongrel dogs (15.5–20 kg) were used. Hemodynamic parameters were continuously monitored at a fixed rate of 80 beats/min. The LCX was exposed with the use of an Octopus Tissue Stabilizer. After baseline data were obtained, each dog was placed in the Trendelenburg position. Finally, RHB was established with different pump flows. LCX exposure caused a significant decrease in aortic flow (to 33.1% ± 13.1% of the baseline value) and arterial mean pressure (to 68.3% ± 8.5%) (P < 0.001). Trendelenburg positioning caused these values to recover to 57.1% ± 6.7% and 72.5% ± 7.7%, respectively. RHB with 50% flow significantly improved the hemodynamic values, although 100% flow significantly increased LAP by 134.8% ± 19.7% (P < 0.01). Tilting of the canine heart to expose the LCX caused significant deterioration of the hemodynamic values. Trendelenburg positioning was moderately effective, and RHB very effective, in improving the hemodynamics. In a limited number of cases, an appropriate flow of RHB may provide safe hemodynamic assistance during off-pump CABG of the LCX. Received: March 10, 2000 / Accepted: May 27, 2000     

心脏瓣膜手术同期冠状动脉旁路移植术的临床探讨

目的 探讨心脏瓣膜手术同期冠状动脉旁路移植术的治疗效果.方法 回顾性分析2010年1月至2013年8月新疆医科大学第一附属医院心脏外科心脏瓣膜手术同期行冠状动脉旁路移植术45例患者的临床病例资料,对其进行整理统计分析,评价治疗效果.结果 患者术后左心室舒张末径较前明显减小,差异均有统计学意义（P＜0.01）;左心室射血分数较术前明显升高,差异均有统计学意义（P＜0.05）.术后早期（住院期间）死亡3例,其中2例发生低心排综合征、1例室颤均抢救无效死亡.通过电话及门诊复查,随访3～24个月,2例失访,失访率4.44％,无一例死亡.结论 心脏瓣膜手术同期行冠状动脉旁路移植术的治疗效果满意.充分的术前准备、合理的手术方案、有效的心肌保护措施、熟练的手术技术及术后的重症监护治疗是手术成功的关键.