非体外循环下冠状动脉旁路移植术

目的 总结110例非体外循环心脏跳动下冠状动脉旁路移植术经验，探讨其手术适应证、优缺点及手术方法。方法 常温、全身麻醉，胸正中切口，非体外循环心脏跳动下，应用特殊心表固定器行冠状动脉旁路移植术，平均搭桥3．9支，血管桥为乳内动脉、大隐静脉及桡动脉。结果 全组无手术死亡，术后心绞痛症状消失。手术时间平均为210min，术后气管插管时间平均为4．8h。术后住院时间平均为10d，住院费用平均为4．4万元。其中3例术中出现不可逆血压过低、室颤而转为体外循环冠状动脉旁路移植术。结论 非体外循环心脏跳动下冠状动脉旁路移植术是一种安全、有效的治疗方法。特别适合于老年及心功能差的患者，可减少体外循环并发症，缩短术后住院时间，降低住院费用，但不能完全替代体外循环旁路移植术。

Off-pump coronary artery bypass grafting

Objective To summarize experience of 110 cases of off-pump coronary artery bypass grafting (OPCAB) and discuss its indication,advantage and disadvantage and operation method.Methods Generally anesthetized at the normal temperature,mid-thoracic incision was proceeded.Under the off-pump and with the special fixing device,coronary artery bypass grafting was conducted.And the number of average bridgings was 3.9,and the cardiac bridgings were from internal mammary artery,great saphenous vein and radial artery.Results There was no operational death in the whole group and angina pectoris vanished after operation.The operation time averaged 210 minutes,the time of tracheal intubation averaged 4.8 hours,residence after operation averaged 10 days and expense averaged 44,000 yuan.Of the 110 cases,irreversible hypotension and ventricular fibrillation occurred in 3 cases and coronary artery bypass grafting by extracorporeal circulation was conducted.Conclusions OPCAB is a safe and effective therapy,especially suitable for the old and the patients with poor cardiac function.It can reduce the complication of extracorporeal circulation,shorten the residence in hospital and decrease the expense.However,it cann't completely replace conventional coronary artery bypass grafting (CCABG).