多点心包悬吊在非体外循环冠状动脉旁路移植术中的临床应用研究

目的 探讨深部多点心包悬吊固定在非体外循环冠状动脉旁路移植术中的临床应用效果.方法 选择30例高危冠心病患者,术中采用深部多点心包悬吊固定点,依次自左上肺静脉、上下肺静脉入口之间、下肺静脉和下腔静脉入口左侧2 cm缝合4～5根心包牵引线,套橡皮管后依次拉紧,逐渐使心包从浅至深呈面状抬高心脏.结果 手术部位显露良好,操作方便,靶血管吻合顺利,无被迫转为体外循环手术,无围手术期心肌梗死、中风等并发症发生.1例二次开胸止血,1例切口感染.住院8～14 d,全部治愈出院.结论 多点深部心包悬吊固定可保证非体外循环冠状动脉旁路移植手术显露充分,手术野清晰,有利于操作.因血流动力学平稳,对高危患者更具有明显优势.

MULTIPLE PERICARDIAL STAY SUTURE TECHNIQUE IN TREATING HIGH RISK PATIENTS WITH OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

Objective To study the therapeutic effect and its clinical application of multiple pericardial stay suture technique in treating high risk patients by using off-pump coronary artery bypass grafting(OPCAB). Methods 30 cases with high risk factors were treated with multiple pericardial stay suture technique.4-5 sutures were placed in the pericardium near the left upper pulmonary vein,between the left upper and inferior pulmonary vein,and near the inferior pulmonary vein and the inferior caval vein.The sutures were snared down to the posterior pericardium by using tourniquets and elevating the heart gradually to get excellent exposure of target vessels.Results There were no operative deaths,perioperative myocardial infarction,stroke,or conversion to extracorporeal circulation.One case suffered from infection in wounds.One had chest re-surgery.The hospitalization period was 8 to 14 days.Conclusion The multiple pericardial stay suture technique can keep the homodynamic situation more stable during operations.This technique can be safely used to produce good surgical results in OPCAB for high risk patients.