冠心病伴重度心功能不全患者非体外循环冠状动脉旁路移植术22例临床分析

目的:分析心功能不全冠心病患者行非体外循环冠状动脉搭桥(OPCABG)的临床资料,总结围术期规律,提出治疗方法。方法:回顾性分析2008年1月至2012年6月,同一术式手术的22例射血分数(EF)<30%的冠心病患者行OPCABG的资料(组1)。同时随机选择同数目的 EF在30%～40%(组2),>40%(组3)的患者的资料作对比。结果:所有患者均痊愈出院。组1与组3比较,在院术前调整天数,室壁瘤手术例数,IABP使用例数及时间,ICU停留时间,使用强心药种类,术后住院天数和住院费用,差异均有统计学意义(P<0.05)。组2、组3术后住院天数,住院费用差异无统计学意义(P>0.05)。结论:心功能不全患者行OPCABG风险大,手术费用高,所占医疗资源多,应慎重选择病例。此类患者通过合理方式的再血管化,积极的围术期处理,亦可得到良好的治疗效果。

Off-pump coronary artery bypass grafting in 22 patients with severe left ventricular dysfunction

Objective:The data of patients with severe left ventricular dysfunction undergoing OPCABG were analyzed to investigate the safety and efficacy of OPCABG in this high-risk group of patients.Methods: From January 2008 to June 2012,22 patients with severe left ventricular dysfunction,whose left ventricular eject fraction(LVEF) <30%,underwent OPCABG by the same surgeon.At the same time,equal number patients who underwent OPCABG with LVEF between 30%～40%(group2) and >40%(group3) were randomly selected as the control groups.All of their clinical data were analyzed and compared.Results: All patients recovered and were discharged from hospital.Both the prepare time and ICU time were longer in group 1 than that in group 3;the usage of IABP was more often in group 1;thereafter the hospital days and the total cost were significant higher in group 1.Meanwhile,there was no significance in the hospital days and the total cost between group 2 and group 3(P>0.05).Conclusion: OPCABG in patients with severe left ventricular dysfunction is a kind of high risk operation.It costs more,and often has more morbidity.The patients should be carefully selected for operation.Through optimal way of revascularization,and reasonable peri-operative therapy,it could get good results in this group of patients.