左心功能低下患者体外循环心脏不停跳与非体外循环冠脉搭桥的对比研究

目的总结严重左心功能低下冠心病患者行体外循环心脏不停跳搭桥（ONBEATCABG）的临床经验。方法2005年10月至2011年12月我院对47例严重左心功能低下的冠心病患者施行冠状动脉旁路移植术（CABG）。早期行非体外循环搭桥（OPCAB）24例，其中因血流动力学不能维持，紧急转流行ONBEATCABG10例（其中湿备4例）；后期23例手术起始就常规行ONBEATCABG术。比较OPCAB（未转流）及常规ONBEATCABG患者心肌肌钙蛋白I（cTnI）的变化，并分析总结OPCAB及ONBEATCABG在严重左心功能低下患者中的应用情况。结果23例行常规ONBEAT下心脏搭桥（3．28±0．62）支，体外循环（ECC）时间（92．34±28．62）min，无严重并发症发生，术后心绞痛症状消失，心功能明显改善。OPCAB紧急转流10例，搭桥（2．07±0．81）支，ECC时间（150．53±64．31）min，术中放置主动脉内球囊反搏（IABP）2例，术后死亡2例，均死于心功能衰竭。结论严重左心功能低下冠心病患者，相对于OPCAB，ONBEATCABG对心肌的损伤略重，但合理采用ONBEATCABG也是一种安全可靠的手术方法。

A comparison between on-pump beating heart and off-pump CABG in patients with severe left ventricular dysfunction

Objective To summarize the results of the on-pump beating heart （ONBEAT） coronary artery bypass graft（CABG） in patients with severe left ventricular dysfunction. Methods From April 2005 to De- cember 2011, 47 cases with left ventricular dysfunction undertook CABG including 24 cases undertook off-pump CABG（OPCAB）, and there were 10 cases of emergent switching to extracorporeal circulation （ECC） due to unsta- ble hemodynamic. Afterwards 23 cases undertook routine ONBEAT CABG at the beginning of operation. The cTnI were compared between OPCAB group and routine ONBEAT CABG group, and the experience of the ONBEAT CABG were analyzed. Results The level of cTnI of ONBEAT CABG group was higher than OPCAB group. In the routine ONBEAT CABG group, the number of grafts was （3.28±0.62）, the time of ECC was （92.34±28.62）min, and no severe complications happened. The number of grafts of the emergent switch group was （2.07±0.81）, and the time of ECC was （ 150.53±64.31 ）min. Meanwhile, intra-aortic balloon pump was used in 2 eases during oper- ation and 2 eases died of heart failure after operation. Conclusion The myoeardium injury of ONBEAT CABG is slightly heavier than OPCAB, but the reasonable applieation of ONBEAT CABG is safe and eredible for patients with severe left ventricular dysfunction.