冠状动脉旁路移植术治疗冠心病的体会

目的 探讨冠状动脉旁路移植术（CABG）对冠心病的治疗效果.方法 2005年7月至2010年 8月共行冠状动脉旁路移植术 82例,年龄38～78（61.8±12.7）岁,病程3个月至12年;有心肌梗死病史13例（15.6%）,合并高血压56例（68.3%）、糖尿病30例（36.5%）.术前心功能（NYHA）Ⅰ～Ⅲ级,Ⅰ级21例、Ⅱ级48例、Ⅲ级13例.手术在全麻体外循环下进行,取大隐静脉（SVG）与左乳内动脉（LIMA）,左乳内动脉与前降支（LAD）搭桥,其余用大隐静脉搭桥,平均每例搭桥（2.60±0.85）根,二尖瓣成形4例.结果 全组死亡1例,死于急性胰腺炎.术后低心排6例、房颤 10例,并发肺不张2例,4例术后引流多,二次开胸止血,1例术后第3天发现上纵隔增宽,二次开胸清除血块.结论 冠状动脉旁路移植术疗效显著,确切恢复和重建心肌血运,手术安全,结果令人满意.

Treatment experience of coronary artery bypass grafting with cardiopulmonary bypass

Objective To identify the effects of coronary artery bypass grafting （CABG） in treatment of coronary heart disease. Methods There were 82 patients with CABG from July 2005 to August 2010, mean age was （ 61.8 ± 12.7 ）years old （range, 38-78years ）, and 13 patients with myocardial infarction （ 15.6% ）, 56 patients with hypertension（68.3% ）, 30 patients with diabetes（36.5 ）. The Cardiac function （NYHA） were from Ⅰ to Ⅲ, 21 patients of Ⅰ , 48 patients of Ⅱ and I3 patients of Ⅲ. The surgery was done under general anesthesia and cardiopulmonary bypass. The bridge vasculars included saphenous vein （SVG） and left internal mammary artery（LI- MA）. Left internal mammary artery （LIMA） were bridged to left anterior descending artery （LAD）, the other bridges were used of saphenous vein （SVG）. An average bridge vascular was 2.60＋0.85 per patient, and there were 4 patients had mitral valve plastic operation. Results There was 1 patient dead in the whole group who death of acute pancreatitis. And there were 6 patients suffered from low cardiac output postoperation, 10 suffered from atrial fibrillation, 2 suffered from lung atelectasis, 4 suffered form the second thoracotomy to stop bleeding, 1 patient found the widened mediastinum 3 days after the operation, and had second thoracotomy to remove the blood clots. Conclusion The CABG shows significant effect of reconstruction of myocardial blood supply, and the opera- tion is safe.