冠状动脉粥样硬化性心脏病的外科治疗

【目的】总结应用364例冠状动脉旁路移植手术（CABG）治疗冠心病的临床经验。【方法]364例冠心病中男302例，女62例。年龄34～82（64．4±16．8）岁。体重38～89（65．4±21．3）kg。46例在常温心脏不停跳下进行CABG，318例在全麻低温体外循环下进行，经升主动脉灌注含血冷停跳液保护心肌，并于循环心脏跳动下选择好冠状动脉切开部位，若有合并病变存在（如室壁瘤、二尖瓣关闭不全等）需先处理，然后再行CABG。用左内乳动脉326条，大隐静脉764条，蛇形静脉桥108条，平均3条。【结果】354例患者痊愈出院，心绞痛完全缓解。10例术后因低心排死亡。316例随访2个月至6年已恢复正常生活或工作。【结论】CABG是治疗冠心病重要而有效的方法。

Surgical Treatment of Coronary Heart Disease

[Objective] To summarize the experiences of coronary artery bypass grafting （CABG） in trea ting coronary heart disease patients. [Methods] Among the 364 coronary heart disease patients, 302 patients were male and 62 patients were female aged from 34±82 years with the average of 64.4± 16.8 years. Body weight was 38±89kg with the average of （65.4±21.3）kg. CABG was performed in 46 cases at normal body temperature with beating hearts. The rest 318 underwent CABG under hypothermia general anesthesia. Cardi ac muscle was protected with infusion of blood cardioplegia from ascending aorta. Site of incision on coronary artery was chosen while heart was still beating at the stage of parallel circulation. Disorders such as ventricular aneurysm and mitral insufficiency should be treated before CABG. For this group of patients, 326 left internal mammary arteries, 764 saphenous veins and 108 sequence anastomoses were used. Average 3 bridges were done per person. [Results] The 354 patients discharged fully recovered completely free of angina pectoris. Ten patients with CABG died of low cardiac output after operation. Follow-up had been done in 316 patients for 2 months to 6 years, and all of them recovered to normal life or working. [Conclusion] Coronary artery bypass grafting is an important and effective method for treating coronary heart disease.