1110例冠状动脉搭桥术的早期结果

目的　回顾性总结１９９６ 年１ 月以来１１１０ 例冠状动脉搭桥术（ＣＡＢＧ） 的近期疗效,介绍冠心病搭桥术的体会和经验。　方法　体外循环下行ＣＡＢＧ１０４８ 例,非体外循环ＣＡＢＧ６０ 例。心肌保护均采用冷血含钾停跳液,体外循环时间１１５ ±３５ 分钟,主动脉阻断时间７２ ±２４ 分钟,单支搭桥１１０ 例,２ 支搭桥１４５ 例,３ 支搭桥４１５ 例（３７－３ ％） ,４ 支搭桥或４ 支以上４３９ 例（３９－５％） 。搭桥材料：左乳内动脉７５１ 例,大隐静脉８７７ 例,桡动脉１０１ 例,全动脉化７２ 例。合并手术：室壁瘤切除１１２ 例,室壁瘤折叠１４ 例,左室成形５ 例,瓣膜手术４８ 例,室间隔穿孔修补术５ 例。　结果　住院死亡９ 例,死亡率０－８１％ 。其余患者痊愈出院,心绞痛基本缓解。术后并发症：低心排１１ 例,主动脉球囊反搏７例,围术期心肌梗塞２ 例,脑部并发症３ 例,二次开胸止血４ 例。　结论　选择好靶血管和充分血管化是冠状动脉搭桥术的关键。另外要重视围术期处理。

Early results of 1,110 cases of coronary artery bypass

OBJECTIVE: To introduce our experience with Coronary artery bypass. METHODS: From January 1996 to March 1999, coronary artery bypass was in 1110 patients at our hospital. They were 985 men and 125 women, aged 27 - 78 years (57 +/- 9). 500 patients were aged over 60 years. 670 patients had a history of myocardial infarction. 450 patients suffered from instable, and 460 from stable angina. 169 patients had stenosis of the left main trunk (>or= 50%). The heart function of 240 patients was over NYHA class III, the EF of 123 patients was less than 40%. 454 patients were associated with hypertension, 133 with diabetes, 131 with ventricular aneurysm, 48 with valvular disease, and 5 with rupture of ventricular septal. 1048 procedures were performed on hypothermia cardiopulmonary bypass (CPB) and 60 on beating heart. Myocardial preservation was carried out by cold blood cardioplegia with potassium. The average time of CPB was 115 +/- 35 minutes, and that of aortic cross clamp was 72 +/- 24 minutes 110 cases received one graft, 145 cases two grafts, 415 cases three grafts, and 439 cases four and more than four grafts. Left internal mammary artery, great saphenous vein, and radial artery were used as coronary artery bypass conduits on 751, 877 and 101 patients, respectively. Total arterial myocardial revascularization was performed on 72 patients. Concomitant operation included ventricular aneurysmetomy (112 cases), plication (14), left ventriculoplasty (5), valvular procedures (48), repair ventricular septal rupture (5). RESULTS: 1 101 patients were discharged uneventfully. Early death occurred in 9 patients, (0.81%). Complication included low cardiac output (11 cases), introaortic balloon pump (7), perioperative myocardial infarction (2), complication of brain (3), and rethoractomy for bleeding (4). CONCLUSIONS: To identify adequate target vessel and completely revascularize ischemic myocardium are the key of coronary artery bypass. Perioperative treatment is important.