冠状动脉旁路移植术112例围手术期处理

目的探讨冠状动脉旁路移植术(CABG)的围手术期处理经验。方法2001-10～2008-08共施行CABG112例,其中行体外循环CABG106例,行非体外循环冠状动脉旁路移植术(OPCAB)6例;每例移植血管1～4支,平均(2.9±0.8)支。同期行心瓣膜手术6例,室壁瘤切除术3例。结果围术期病死3例(2.7%,3/112),死于低心排血量综合征2例,严重室性心律失常1例。术后发生心房纤颤25例。术后呼吸机辅助时间(12.8±9.9)h,住ICU时间(4.2±2.0)d,术后住院时间(13.2±5.6)d。随访85例(75.9%),随访时间1个月至8年,其中82例(96.5%)无心绞痛复发,心功能(NYHA)恢复至Ⅰ级47例,Ⅱ级30例,Ⅲ级8例。结论加强CABG围手术期处理,可降低手术病死率和并发症发生率,提高手术疗效。

Peri-operative managements of 112 cases undergoing coronary artery bypass grafting

Objective To investigate the peri-operative managements of coronary artery bypass grafting(CABG).Method From October 2001 to August 2008,112 patients with coronary artery disease underwent CABG in authors' hospital.Among them 106 patients underwent conventional(on-pump)CABG and 6 patients underwent off-pump CABG(OPCAB).The number of bypass grafts for each patient was 1 to 5(2.9±0.8).Cardiac valvular operations were performed in 6 patients.Left ventricular aneurysm plasty operation were performed in 3 patients.Result Three deaths occurred peri-operatively(2.7%).Two patients died of low cardiac output and one patient died of ventricular fibrillation after operation.The atrial fibrillation occurred in 25 patients postoperatively.The ventilation time was 12.8±9.9 hours.The intensive care unit stay was 4.2±2.0 days and postoperative in-hospital stay was 13.2±5.6 days.85 patients(75.9%)were follow up,follow-up time was 1 month to 8 years.There were no angina in 82 payients(96.5%).There were 47 patients in New York Heart Association(NYHA)class Ⅰ,30 patients in NYHA class Ⅱ,8 patients in NYHA class Ⅲ.Conclusion Intensive perioperative management can reduce the mortality and morbidity of CABG and improve the operative prognosis.