严重左主干病变急救处理及急诊搭桥术对病人预后的影响

目的 探讨严重左主干病变病人不同处理方案以及外科搭桥手术者对临床预后的影响.方法 回顾性分析了左主干冠状动脉狭窄＞70%病人的临床预后.结果 共发现严重左主干病变24例.冠状动脉造影后无症状者17例(71%),在72 h内接受冠状动脉搭桥术(CABG),手术成功率为100%,住院期间无死亡病例.7例病人在冠状动脉造影后出现心肌缺血症状,其中6例在导管室内、1例在监护室出现室性心动过速,4例在导管室内抢救后,立即植入主动脉球囊反搏(IABP)并行急诊CABG术,成功率为100%.3例因未能及时植入IABP和行急诊CABG,病人均在冠状动脉造影后12 h内死亡.结论 严重左主干病变病人预后凶险,特别是冠状动脉造影后有明显缺血症状的病人,及时置入IABP和行急诊搭桥术,多能改善病人的预后.

Emergency management of patients with severe left main coronary disease and influence of emergency CABG on the patients's prognosis

Objective To explore the influence of different management strategies and surgical coronary artery bypass grafting (CABG) on clinical prognosis of patients with severe left main coronary disease (stenosis>70%).Method Clinical prognosis of patients with severe coronary disease with or without ischemic symptoms after coronary angiogram was analysed retrospectively.Results In past three years,we found 24 patients with severe left main coronary disease.Of them,17 did not have any ischemic symptoms after coronary angiogram.Five and 12 of these 17 cases successfully underwent CABG 12 hours and 72 hours respectively after coronary angiogram,with successful rate of CABG being 100%.There was no death during hospital stay.7 patients had significant ischemic symptoms.Of them,4 patients successfully underwent emergency CABG after successful cardio pulmonary resuscitation and IABP insertion and no death occurred during hospital stay.All other three patients who did not receive IABP insertion died in 12 hours after coronary angiogram although one patient received rescue emergency CABG,one had rescue left main coronary stenting and one was waiting for emergency CABG.Conclusion The prognosis of patients with severe left main coronary disease is cruel,especially in patients with ischemic symptoms after coronary angiogram.Insertion of IABP and emergency CABG may improve the prognosis of these patients.