280例冠状动脉旁路移植术临床分析

目的总结非体外循环冠状动脉旁路移植术(OPCAB)的治疗效果和临床经验。方法选自1998-03~2004-10间280例冠心病(CAD)患者接受冠状动脉旁路移植术(CABG)。OPCAB实施率(即OPCAB占单纯冠状动脉旁路移植术的百分比)为94.7%。平均年龄63.1岁。合并瓣膜病变11例,合并室壁瘤9例。左室射血分数(LVEF)平均47%±14%。5例急诊手术,其中2例术前放置主动脉内球囊反搏(IABP)。32例在常规体外循环下手术;248例采用非体外循环心脏不停跳技术,术中改施体外循环6例。其中5例全动脉化、2例全静脉化旁路移植术。结果平均每例远端吻合口2.95个。4例左前胸部小切口单支病变旁路移植术,其余均为正中切口,多支病变的CABG手术。死亡3例(1.07%)。结论OPCAB手术安全可行,早期效果满意,远期效果有待进一步观察。OPCAB具备独特的技术特点和方法。

Clinical Experience of Coronary Artery Bypass Graft in 280 Cases

Objective To study the clinical experience of surgical treatment in the patients undergone off-pump coronary artery bypass(OPCAB).Methods Two hundred and eighty patients with coronary artery disease underwent coronary artery bypass graft(CABG) between March 1998 and October 2004.The average age was 63.1 years.The ratio of OPCAB to conventional coronary artery bypass grafting(CCABG) was 94.7%,and eleven patients of CABG combined with valve replacement or valve plasty,nine patients combined with left ventricular aneurysm,two patients combined with valve disease and ventricular aneurysm.The mean left ventricular ejection fraction was 47%±14%.Emergency surgical revascularization was performed in 5 patients in whom 2 were treated with intraaortic balloon pump(IABP) before surgery.Thirty-two patients underwent coronary artery revascularization with conventional cardiopulmonary bypass,248 without pump(OPCAB),and 6 patients were converted to CPB.Five patients accepted total arterial revascularization and 2 total venous conduits.Results The number of distal anastomoses was 2.95/pt.There was 3 postoperative deaths with a mortality of 1.07%.Conclusion OPCAB surgery is a safe and feasible procedure with good early results.Its late outcomes need further follow-up.OPCAB requires special skills and methods in practice.