术中改变非体外循环冠脉搭桥术式的原因探讨

目的：探讨非体外循环冠脉搭桥术中被迫改变为体外循环下施术的原因和处理、预防措施。方法：1999年3月－2001年3月不完全统计OPCAB手术143例，术中23例出现严重影响手术继续进行的心律失常、血压波动，其中6例（3％）术中被迫转变为体外循环下施术，其直接原因是：①不能转复的严重心律失常（房颤并室上速1例，室速、室颤3例）。②不能耐受显露靶血管搬动心脏而出现持续性血压下降（2例）。结果：肾急转变为体外循环下完成手术。无手术死亡和术后早期严重并发症发生。结论：术前准备不充分，手术适应症选择不当和术中对意外情况处理欠妥与发生术中被迫改变术式的直接原因有关。

Cause of Changing Off-Pump to Pump Coronary Artery Bypass Grafting in Operation

: To analysis the causes of changing off-pump to pump coronary artery bypass grafting. Methods: From March 1999 to March 2001 ,6 patients in 143 had to change off-pump to pump coronary bypass grafting . The directive causes were uncontrolliable arrhythmia(4 cases) and continuous blood pressure dropping (2 cases) in operation. Results: It had to change operative type forcedly to complete operation with the cardiopulmonary bypass. No death and postoperative complications. Conclusion: Inadequate preoperative treatment, operative incentive and anaesthetic problem the causes of leading uncontrolliable arrhythmia and continuous blood pressure dropping in operation that relate to change operative type.