非体外循环下冠状动脉搭桥术在高危老年冠心病患者中的应用

目的总结非体外循环下冠状动脉搭桥术(OPCABG)在高危老年冠心病患者中的应用经验。方法 2005年1月至2009年12月对23例高危老年冠心病患者行OPCABG治疗。手术在常温全麻下进行,采用前胸正中切口显露心脏。2例直接采用大隐静脉(SV)行SV-左前降支(LAD)搭桥;9例取乳内动脉(IMA)和SV,行IMA-LAD、升主动脉-SV序贯搭桥;12例取IMA和SV,行IMA-LAD、升主动脉-IMA搭桥。结果全组手术均顺利完成,无转体外循环完成手术者;总共搭桥74条,平均每例搭桥3.1条;早期死亡1例,出现呼吸衰竭1例,急性左心衰1例,术后出血二次开胸手术2例,胸骨感染1例;术后心绞痛完全缓解20例,明显缓解2例。结论高危老年患者行OPCABG是一种安全、有效的方法 ,特别对一些不能耐受体外循环的患者是一种可行的方法 。

Off-pump coronary artery bypass grafting for coronary artery disease in high-risk older patients

Objective To summarize the experience of off-pump coronary artery bypass grafting（OPCABG） in the treatment of coronary artery disease in high-risk older patients.Methods From January 2005 to December 2009,23 cases of high risk older patient with coronary artery disease underwent OPCABG surgery.The surgery was carried out under anesthesia at room temperature,with cardiac chest exposed by median sternotomy.Results The surgery achieved success without cardiopulmonary bypass.One patient died of cardiacarrhythmia early after operation.One case of respiratory failure,1 case of acute left heart failure and 1 case of sternum infection were discovered respectively.Two patients underwent surgical hemostasis through the second thoracic surgery due to bleeding.Complete and significant remission of angina after suegery occurred in 20 and 2 patients respectively.Conclusion OPCABG is a safe and effective method to treat coronary artery disease in high-risk older patients.