冠状动脉旁路手术和血管成形术的临床价值

目的 通过对冠状动脉旁路手术（ＣＡＢＧ）和经皮腔内冠状动脉成形术（ＰＴＣＡ）的临床疗效的分析，评价两者的临床应用价值。方法 随机选取ＣＡＧＢ１２１例，ＰＴＣＡ９９例，两组之间年龄、体重、心功能、病种及病变血管部位差异均无显著性，但受累血管范围峡谷组不一，ＣＡＢＧ组１支５４例，２支５８例，３支９例；ＰＴＣＡ组１支９８例，２支仅１次，比较两组之间手术成功率、早期心绞痛缓解率、手术病死率和１年内再入院率     

冠状动脉旁路移植术76例临床分析

为评价冠状动脉硬化病（ＣＡＤ）病人行冠状动脉旁路移植术（ＣＡＢＧ）后的病死率及远期效果。方法总结了从１９９４年９月至１９９７年５月为７６例ＣＡＤ病人行ＣＡＢＧ的临床资料及术后１个月至２年８个月的随访资料。结果手术死亡２例，病死率为２．６％，术后心排血量（４．９６±１．５６）和心脏指数（２．７５±０．７６）较术前（分别为３．８８±１．７４和２．１７±１．０６）明显增加（Ｐ＜０．０１），余７４例在随访中仅２例出现心绞痛发作，心绞痛缓解率为９７％。结论ＣＡＢＧ可改善冠心病心肌缺血，消除心绞痛，提高病人生活质量。     

经皮腔内冠状动脉成形术和冠脉内支架植入术初步应用

目的 探讨冠状动脉成形术（ＰＴＣＡ）和支架植入术（ＣＡＳＩ）在冠心病中应用。方法 按Ｇｒｕｅｎｔｚｒｉｇ方法对７例冠心病患者的７支血管行ＰＴＣＡ或支架植入术。结果 行ＰＴＣＡ治疗４例、ＰＴＣＡ＋ＣＡＳＩ２例，直接ＣＡＳＩ１例、ＰＴＣＡ未成功１例，共扩张病变血管７处。达到完全性血运重建２例、部分血运重建４例，术中出现严重内膜撕裂１例冠心病无死亡病例，术后随访６例心绞痛完全消失，心功能明显改善。未成功     

冠状动脉旁路术治疗冠心病36例体会

应用冠状动脉旁路移植术（ＣＡＢＧ）治疗冠心病３６例,均为多支冠状动脉病变。２７例左心室射血分数〉４５％,９例４５％￣３０％,除１例在非体外循环左外侧小切口下手术,余均在体外循环下进行,１０例采用乳内动脉与左前降支搭桥,余均为大隐静脉桥。结果３６例ＣＡＢＧ取得满意的临床效果,除１例手术死亡外,其余病例心绞痛均得到明显缓解。笔认为,ＣＡＢＧ术是治疗冠心病的一种安全有效的方法,近期临床效果满意。     

应用IABP于体外循环中产生搏动血流在高危冠状动脉搭桥病人中的应用

本报告２例高危冠心病行冠状动脉搭桥的病人，均为男性，年龄分别为７２及６９岁，均为三支病变，不稳定心绞痛ＣＣＳ ＩＶ级，术前例１置入ＩＡＢＰ７天，例２为９天，其中例２为急性非Ｑ波心肌梗塞。２例病人均在全麻，微温（３２－３４℃）体外循环下行冠状动脉搭桥术，术中应用４：１温血停跳液保护心肌，在体外循环期间继续使用ＩＡＢＰ，心脏跳动下应用心电Ｒ波触发，心脏停跳后改成机内频率，２例病人均搭桥四支，术中ＣＰ     

BCG膀胱灌注加全身化疗预防膀胱癌术后复发35例效果分析

３５ 例膀胱经肿瘤局部切除或加膀胱部分切除、ＴＵＲＢＴ 后,予ＢＣＧ 灌注２ 年,并予Ｍ－ ＶＡＣ 方案静脉化疗１ ～２ 疗程。随访１～６ 年,结果,３４ 例已存活４ 年６ 个月,１ 例７ 个月后复发。认为膀胱癌手术切除,加ＢＣＧ膀胱灌注,静脉化疗方法,可显著降低术后复发率。     

BCG膀胱灌注加全身化疗预防膀胱癌术后复发35例效果分析

３５例膀胱经肿瘤局部切除或加膀胱部分切除、ＴＵＲＢＴ后,予ＢＣＧ灌注２年。并予Ｍ－ＶＡＣ方案静脉化疗１－２疗程,随访１￣６年,结果,３４例已存活４年６个月,１例７个月后复发。认为膀胱癌手术切除,加ＢＣＧ膀胱灌注,静脉化疗方法,可显著降低术后复发率。     

准分子激光冠脉成形术─—附8例报道

本文报道准分子激光冠脉成形术（ＥＬＣＡ）８例，均为男性，年龄平均６１岁。心梗４例（２例有梗塞后心绞痛），４例仅表现为心绞痛。冠脉造影显示ＬＡＤ狭窄６支，ＬＣＸ狭窄４支，ＲＣＡ狭窄４支。按ＡＣＣ／ＡＨＡ分型Ｂ型５例，Ｃ型３例。均用ＥＬＣＡ＋ＰＴＣＡ。根据血管直径选用１．３ｍｍ（能量密度１４．５ｍＪ）和１．６ｍｍ（能量密度２１．０ｍＪ）激光导管，频率２０Ｈｚ。１例导引钢丝未能通过狭窄，ＥＬＣＡ失败，另１例二次心梗，经旁路移植后仍有心绞痛发作，心功能较差，其ＥＬＣＡ虽获成功，但因病情严重死亡。８例中ＥＬＣＡ成功７例，手术成功６例。     

不同检测方法对血糖水平的影响

对１００例行ＯＧＴＴ或馒头餐试验对象作了末梢及静脉血糖检测的比较研究，结果显示：静脉血清血糖（ＶＳＧ）明显高于静脉全血糖（ＶＢＧ），两者相差系数１．０９９；ＶＳＧ亦高于末梢全血糖（ＣＢＧ），两者相差系数１．０８５。ＶＳＧ与ＶＢＧ或ＣＢＧ间均有良好的相关性（Ｐ＜０．０１），当ＶＳＧ≤７．２及７．３～１１．１ｍｍｏｌ·Ｌ－１时，ＶＳＧ与ＣＢＧ间差异不明显，而血糖为１１．２～１６．７及＞１６．７ｍｍｏｌ·Ｌ－１时两者差异较显著。表明ＶＳＧ与ＶＢＧ及ＣＢＧ间均有良好的吻合性及换算系数。     

全麻复合硬膜外阻滞用于食管癌根治术

我们对进行食管癌根治术的病人采取全麻复合硬膜外阻滞的方法,并在术后施行硬膜外镇痛,取得良好的效果。现将有关情况报道如下：１　资料与方法１．１　一般资料：本组病人２８例,ＡＳＡⅠ～Ⅱ级,女６例,男２２例,年龄４１岁～６９岁,均为食管癌患者,需开胸进行手术,术前检查心、肝、肾功能正常,血电解质正常,无呼吸系统疾患。１．２　麻醉方法：麻醉前给药阿托品０５ｍｇ或东莨菪碱０３ｍｇ肌注。术中监测ＢＰ、ＭＡＰ、ＨＲ、ＥＣＧ、ＳｐＯ２。先选择Ｔ６－７间隙行硬膜外腔穿刺,向头端置管,固定导管,封闭穿刺部位,硬…     

DSCT数字化血管成像对冠状动脉搭桥术后桥血管的评价

目的：探讨DSCT数字化血管成像对冠状动脉搭桥术后随访应用价值。方法：采用西门子DSCT（Siemens SOMATOM Definition）对16例行冠状动脉搭桥术后患者行DSCT冠状动脉检查,分别评价CT图像桥血管近远端吻合口、桥血管本身有无狭窄、钙化和吻合口远端引流血管的图像质量及冠状动脉图像质量,评价双源CT诊断桥血管通畅性和冠状动脉是否存在狭窄。结果：DSCT显示16例患者共发现桥血管42根,其中6根闭塞,所有桥血管均可评价。42支桥血管中,25支未见狭窄,9支桥血管狭窄程度≤50％,8支桥血管狭窄程度〉50％。搭桥血管通畅率为85．7％（36／42）,乳内动脉桥通畅率较高,为88．9％（8／9）,肱动脉次之,为85．7％（6／7）,大隐静脉桥通畅率最低,为76．9％（20／26）。结论：DSCT数字化血管成像作为一种无创性检查在冠状动脉桥血管随访的诊断和评价中是安全可靠的。     

电子束计算机断层血管造影及三维重建在冠状动脉搭桥术后的临床应用

目的探讨电子束计算机断层（ＥＢＣＴ）血管造影及三维重建在冠状动脉搭桥术后的临床应用价值。方法均采用单层增强扫描（ＳＳＭ）和血流扫描（ＦＬＯＷＳＴＵＤＹ）；三维重建采用表面阴影显示法（ＳＳＤ），并与手术结果做了对照，其中７例有术后造影检查结果。结果１５０例ＥＢＣＴ扫描及三维重建均获得成功；３９９支搭桥血管中有３１８支显示通畅，通畅率为７９７％；其中，１００支乳内动脉桥中８７支通畅（占８７％），２９６支大隐静脉桥中２２８支通畅（占７７％），３支桡动脉桥全部通畅（１００％）。７例患者ＥＢＣＴ结果显示１２支桥有５支发生了阻塞，与其造影结果一致。结论ＥＢＣＴ是评价搭桥血管通畅与否的很有价值的无创方法，并有望取代常规心血管造影。     

电子束计算机断层血管造影及三维重建在冠状动脉搭桥术后的临床 …

目的 探讨电子束计算机断层（ＥＢＣＴ）血管造影及三维重建在冠状动脉搭桥术后的临床应用价值。方法 均采用单层增强扫描（ＳＳＭ）和血流扫描（ＦＬＯＷ ＳＴＵＤＹ）;三维重建采用表面阴影显示法（ＳＳＤ）,并与手术结果做了对照,其中７例有术后造影检查结果。结果 １５０例ＥＢＣＴ扫描及三维重建均获得成功;３９９支搭桥血清血管中有３１８支显示通畅,通畅率为７９．７％;其中,１００支乳内动脉桥中８７支通畅（占８     

1004例胸廓内动脉-冠状动脉旁路术的体会

根据1004例胸廓内动脉(IMA)-冠状动脉旁路术的临床实践,对比手术的优缺点并讨论手术适应证和禁忌证,全组病例男性817例,女性187例;年龄27～83岁。其中10%仅采用IMA作为旁路血管,90%还同时进行1～4支大隐静脉旁路术。住院死亡率1.8%,围术期梗塞发生率2.6%。本组资料指示IMA可适用于心肌血运重建手术,其主要优点是远期通畅率高达90%。主要缺点为仅限于与近端1或2支冠状动脉吻合,手术操作要求较大隐静脉冠状动脉吻合术高,以及手术后肺部并发症机会较多,但随着经验的增加,上述缺点正被逐渐克服,IMA旁路术的安全性至少与大隐静脉旁路术相同,且其远期通畅率高于后者,看来IMA在冠状动脉血运重建手术中的地位正日益得到重视。     

Three-dimensional reconstruction of electron beam computed tomography angiography for evaluating coronary artery bypass grafts

OBJECTIVES: To probe into electron beam computed tomography (EBCT) angiography and 3-D reconstruction of coronary artery bypass grafts (CABG) and to evaluate the clinical application of EBCT angiography and 3-D reconstruction of CABG. METHODS: EBCT angiography with 3-D reconstruction was achieved in 150 patients (142 men and 8 women, mean age, 57 +/- 8 years) with 399 grafts including 100 internal mammary artery grafts (IMG), 296 saphenous vein grafts(SVG) and 3 radial artery grafts (RAG) respectively. The time from bypass surgery to EBCT scanning ranged from 7 days to 120 months, averaging 15 +/- 28 months. Enhanced single slice mode (SSM) and flow studies were performed in all patients. The results of 3-D reconstruction of CABG were compared with bypass operation records and with coronary arteriograms (7 patients). RESULTS: 150 patients underwent successfully EBCT angiography and CABG 3-D reconstruction. According to 3-D reconstruction of the coronary bypass grafts with flow studies, 318 of 399 coronary bypass grafts were patent including IMG patency in 87/100 (87%), SVG in 228/296 (77%) and RAG in 3/3 (100/100). The overall patent rate was 79.7%. In 7 patients with 12 coronary bypass grafts, EBCT studies showed graft patency (7 grafts) and occlusion (5), which were confirmed by conventional graft angiography. CONCLUSIONS: EBCT angiography with 3-D reconstruction is effective in providing the entire anatomic structure of coronary bypass grafts and evaluating coronary bypass graft patency. EBCT flow study can provide quantitative data for evaluating coronary bypass graft patency and for supplemental diagnosis of CABG 3-D reconstruction. EBCT angiography is a noninvasive technique that could replace conventional coronary arteriography for follow-up survey of coronary bypass surgery in future.     

双源CT在冠状动脉旁路移植术后随访中的应用

目的 探讨双源CT在冠状动脉搭桥术后的临床应用及其价值.方法 对2009年1月～2010年8月期间27例冠状动脉搭桥术（CABG）后患者的CTA影像资料进行分析,对桥血冠状动脉管狭窄进行诊断.其中有10例患者同期行选择性冠状动脉造影术.结果 所有患者顺利完成冠状动脉图像采集,所有桥血管均显影,并且都可进行评价,其中共15条桥血管出现狭窄.和CAG结果相比,双源CT对狭窄判断的敏感性100%、特异性91.3%、准确率93.1%,出现狭窄的血管与血管类型有关,2年内通畅率动脉桥高于静脉桥.结论 双源CT可以准确评价冠状动脉桥血管通畅情况,是术后评价冠状动脉桥血管病变的首选检查方法.     

Coronary bypass revascularization with radial artery and internal mammary artery grafts

Objective To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coron ary artery bypass and the use of color Doppler ultrasound in the peri- operative evaluation of IMA and radial- ulnar collateral circulation. Methods From June 1998 to June 2000, sixty cases of coronary bypass revascularization wi th RA and IMA were performed. Preoperatively, the radial- ulnar collateral circ ulation was evaluated with the modified Allen’s test, color Doppler ultrasound a nd noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperat ively and postoperatively. Results One patient (1. 7%) died of serious cardiac arrhythmia on the fourth postoperati ve day. There were no arterial graft harvest related complications. Before har vesting, the ulnar artery blood flow was 30. 78±9. 71 ml/min, and it increased to 43. 36±13. 98 ml/min (40. 87% increase, P<0. 01) after the operation. Compared with the baseline, there was no obvious change of IMA blood flow posto peratively (P>0. 05), but the systolic/diastolic flow ratio markedly dec reased from 8. 57±3. 98 ml/min to 3. 41±4. 87 ml/min (P<0. 01). Conclusions Arterial grafts can be safely used for coronary bypass revascularization with go od results. The ulnar artery blood flow can increase compensatively after RA ha rvesting. The diastolic blood flow of grafted IMA markedly increased postoperat ively. Color Doppler ultrasound was very helpful both in evaluating the radial - ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).     

非体外循环冠状动脉搭桥术临床分析（附11例报告）

（1）目的 总结探讨11例非体外循环冠状动脉搭桥术（OPCAB）的经验。（2）方法 2001年6－12月对11例冠心患采用非体外循环心脏不停跳方法完成冠状动脉搭桥术。（3）结果 共搭桥35支，平均3．17支／例，其中左乳内动脉桥8支，大隐静脉桥27支。6例患（54．5％）未血，无手术死亡及并发症。（4）结论 非体外循环搭桥术克服了体外循环搭桥术（CABG）的诸多缺点和弊端，手术简化，时间缩短，适应证扩大，并发症明显减少，效果满意。     

Coronary artery bypass grafting for Kawasaki disease

Background Kawasaki disease （KD） is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting （CABG） in patients with KD. Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient （mean 2.5±0.8）. Various bypass grafts were used in patients, i.e. the left internal mammary artery （LIMA） in 3 patients, bilateral internal mammary artery （IMA） in 2 patients, LIMA plus gastroepiploic artery （GEA） in 1 patient and total saphenous vein grafts （SVGs） in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass （CPB）, after being supported with intra-aortic balloon pump （IABP）, the patient was weaned from CPB successfully. Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months （mean 27 months）, clincal angina disappeared or improved. Cardiac function was in Class I-II （NYHA）.Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.     

不阻断主动脉冠状动脉搭桥术疗效分析

目的报道 10例不阻断升主动脉的冠状动脉搭桥术的疗效。　方法体外循环低温室颤冠脉搭桥术2例 ;非体外循环冠脉搭桥术 8例。其中三支病变 8例 ;双支和单支病变各 1例。前降支 10例 ,回旋支 6例 ,后降支 2例 ,左主干开口 2例 ,右冠脉 7例。移植血管 :左乳内动脉 7支 ;大隐静脉 2 0支。　结果　术后 1例死于慢性左心衰 ,9例存活 ,心绞痛消失。结论不阻断升主动脉的冠脉搭桥术创伤轻 ,死亡率低 ,并发症少 ,费用低 ,尤其非体外循环冠脉搭桥术更具优越性