冠状动脉搭桥手术24例临床分析

目的总结冠状动脉搭桥手术的临床经验及远期疗效.方法施行冠状动脉搭桥术24例,在中度低温体外循环下手术, 游离左乳内动脉和大隐静脉,胸骨正中切口建立体外循环,在并行循环下分离出冠状动脉吻合部位,行冠状动脉搭桥术.急症手术2例,常温不停跳非体外循环冠状动脉搭桥术4例,其中用左前外侧小切口乳内动脉-左前降支搭桥2例.结果全组搭1支桥3例、2支桥6例、3支桥15例,平均搭桥2.5支.LIMA桥20支,桡动脉桥3支,RIMA桥1支.用静脉桥作Y型桥吻合并序贯搭桥6例, 全静脉桥4例,全动脉桥3例,包括1例双侧乳内动脉搭桥,左桡动脉搭桥3例,全动脉化搭桥均应用了乳内动脉和左桡动脉3例, 部分年龄大于75岁者用全静脉桥.20例主动脉阻断时间31～124分钟,平均67分钟,转流时间45～321分钟,平均96分钟.术后因呼吸衰竭带呼吸机大于1周、气管切开并肺部感染、胸骨裂开前纵隔感染5例;行再次清创缝合固定胸骨治愈3例,其中1例肺部严重感染、大量痰液经气管造瘘口窜入胸骨后导致严重感染,监护室监护1个月治愈出院;上消化道出血3例,其中大出血死亡1例;其余病人无心绞痛症状,心功能恢复到I～II级,顺利出院,无远期死亡.结论:冠状动脉搭桥手术比较安全,并发症发生率不高,文献报道手术死亡率1.7%～3.3%, 本组死亡率4%.

Coronary artery bypass grafting in 24 patients

Objective To report the clinical results of coronary artery bypass grafting (CABG) in 24 patients treated in our hospital Methods Twenty four consecutive patients underwent coronary artery bypass grafting The age ranged from 38 to 78 years with a mean of 62 5 years Three patients had one vessel disease, 6 had two vessel disease, and the remaining 15 had three vessel disease Four patients had left ventricular aneurysm, and 13 patients combined with chronic obstructive pulmonary disease The access was through a left anterior minithoracotomy incision in 2 patients, and standard midline sternotomy incision in 22 patients The average bypass per patient was 2 5 Results One patient died of acute upper gastrointestinal hemorrhage All other patients who survived operation were followed up and they all free of angina pectoris Conclusion CABG is an alternative treatment for coronary disease in selected patients The early result is satisfactory with a low complication and death rate