非体外循环冠状动脉旁路移植术在高危冠心病中的应用

目的 探讨用非体外循环冠状动脉旁路移植术(OPCAB)的方法，以避免体外循环对冠心病高危因素患者产生的不良影响。方法 对100例冠心病患者行OPCAB，其中69例伴有冠心外科手术的高危因素。血管病变主要涉及左、右冠状动脉各分支。结果 手术死亡1例(1.4％)，手术转换2例(2．9％)，移植血管失功1例(1.4％)，术后非致命性心肌梗死4例(5．8％)，肾功能衰竭1例(1．4％)，胸骨感染1例(1．4％)，24小时内拔除气管内插管68例(98.6％)，接受输血17例(25．O％)。术后随访56例，随访时间1—13个月，死亡2例，心绞痛复发4例，充血性心力衰竭2例。术后无脑血管意外、再次手术止血、室性心律失常、下胶切口感染和呼吸衰竭等并发症发生。随访病例中14例做冠状动脉血管造影术，仅1例移植血管狭窄大于50％。所有乳内动脉血管桥均通畅。结论 对某些具有冠心外科手术高危因素的患者，采用OPCAB可降低并发症发生率和手术死亡率。然而，这种技术较适用于冠状动脉解剖条件较好的病例。远期结果需要长期随访进一步加以证实。

Initial experience of off-pump coronary artery bypass grafting in high risk patients

Objective In an attempt to avoid the deleterious effects of cardiopulmonary bypass(CPB) , especially in high risk patients, off-pump coronary artery bypass grafting (OPCAB) is now an accepted technique of myocardial revascularization in a special subset of patients. Methods OPCAB was performed on 100 patients between April 1998 and June 2002. Patients were selected on the basis of coronary anatomy, with significant stenosis in the left coronary and right coronary, 69 of them had high risk factors. Results Early unfavorable outcome events included operative death in 1 patient (1 4%), conversion to CPB in 2 patients (2.9%) , graft failure in 1 patient (1 4%), nonfatal perioperative myocardial infarction in 4 patients (5.8%), renal failure in 1 patient (1 4%), sternal infection in 1 patient (1.4%), blood transfusion in 17 patients (25.0%), and extubated within 24 hrs in 68 patients (98.6%). Early follow-up 1-13 months after operation showed two death, four patients with recurrence of angina, and two patients with congestive heart failure. There was no incidence of stroke, reentry for bleeding, ventricular arrhythmia and leg wound infection. Graft patency was investigated using angiography in 14 patients. One patient grafts were narrowed by more than 50%. All internal mammary artery grafts were widely patent. Conclusions OPCAB can be performed with relatively low operative mortality and morbidity in certain high risk subgroups of patients with symptomatic coronary artery disease. However, this procedure should be considered only for patients with suitable coronary anatomy. Longer follow-up is needed to further clarify patient selection and the long-term outcome of this approach.