重度肺功能减退患者的冠状动脉旁路移植术

目的　探讨重度肺功能减退患者行冠状动脉旁路移植术的方法和围术期处理。方法　 2 1例重度肺功能减退患者均为混合性通气功能障碍 ,以限制性通气功能障碍为主者 4例 ,以阻塞性通气功能障碍为主者 17例。 6例在常规体外循环下行冠状动脉旁路移植术 (CCABG) ,15例为非体外循环下冠状动脉旁路移植术 (OPCAB)。结果　术后出现呼吸系统并发症 9例 ,呼吸衰竭 4例 (CCABG3例 ,OPCAB1例 )。 1例因多器官功能障碍并发上消化道大出血死亡 ,余患者痊愈出院。结论　术前充分的准备、术中选择OPCAB、术后良好的呼吸道管理 ,有助于提高重度肺功能减退患者冠状动脉旁路移植术的效果

Coronary artery bypass grafting for coronary heart disease with severe pulmonary dysfunction

Objective To evaluate perioperative managements of patients with coronary heart disease and severe pulmonary dysfunction undergoing coronary artery bypass grafting (CABG).Methods The clinical data of 21 patients with coronary heart disease and severe pulmonary dysfunction who had undergone CABG were reviewed retrospectively.All patients had mixed ventilative insufficiency.The main problems in 4 patients were restrictive ventilative insufficiency and that in 17 patients were obstructive ventilative insufficiency. Six patients received conventional CABG (CCABG) and 15 patients underwent off-pump coronary artery bypass grafting (OPCAB).Results Early respiratory system complications occurred in 9 patients ,among them 4 cases (3cases occurred in CCABG and 1 in OPCAB) had respiratory failure.One patient died of upper digestive tract bleeding and multiple organ dysfunction syndrome (MODS).Conclusion Excellent preoperative preparation,OPCAB technique and appropriate postoperative management of respiratory tract are pivotal factors of improving effect of CABG for coronary heart disease with severe pulmonary dysfunction.