700例冠状动脉旁路移植术的临床回顾

作者对阜外医院７００例冠状动脉旁路移植术（ＣＡＢＧ）患者的临床资料和手术结果，按时间分Ａ、Ｂ两组进行对比分析，结果显示合并糖尿病、高血脂症、心功能Ⅲ～Ⅳ级、左主干病变、广泛三支病变等在患者中所占比例近三年有显著的增高（Ｐ＜０．０５）；合并高血压病（４１．３％）、陈旧性心肌梗塞（６５．０％）、有左室室壁瘤（２４．３％）、术后需使用ＩＡＢＰ（９．４％）发生率高，但两组间无显著性差异。心肌保护方法的改进、冠状动脉充分再血管化技术的提高和内乳动脉的广泛采用，使术后早期死亡率（Ｂ组９．６％，Ａ组２．７％）及围术期心梗发生率（Ｂ组９．０％、Ａ组３．２％，Ｐ＜０．００５）明显下降。

A clinical review of 700 cases of coronary artery bypass grafting

To assess the changing trends in patients profiles,operative procedures,and the result of coronary artery bypass grafting (CABG) we reviewed the clinical data of 700 consecutive patients who had anisolated CABG (471, 67 3%), CABG combined with left ventricular aneurysm (170, 24 29%),CABG and valve procedures (48,6 9%),CABG and ventricular septal defect repair (16, 2 3%) at the Fuwai Hospital. The patients were divided into group A (recent three years) and group B (before 1993). The incidence was significantly increased ( P <0 05) in diabetes,hypercholesterolemia,ventricular dysfunction,left main stem coronary artery disease and three vessles lesion. There was a high incidence of hypertension (41 3%),old myocardiac infarction (36 4%),combined left ventricular aneurysm (24 29%) and IABP needed (9 4%), however no significantl difference was notes between the two groups.Internal mammary artery was used in group A ( 25 6%) and group B ( 2 6%) ( P <0 005). The hospital mortality (group A , 2 7% and group B, 9 6%) and perioperative myocarial infarction (group A ,3 2% and group B, 9 0%) decreased significantly ( P <0 005).We conclude that despite a high incidence of hypertension,diabetes,hypercholoesterolemia,old myocardial infarction,ventricular dysfunction and diffuse coronary artery disease the patients tolerate CABG surgery well and obtain a good result.