不停跳冠状动脉搭桥术64例临床分析

目的 总结不停跳冠状动脉搭桥术（OPCAB）的临床经验.方法 2007年7月至2011年11月共完成OPCAB 64例.全麻气管插管后,连续有创动静脉压监测,血管活性药物微量泵注入,肝素化后维持部分激活凝血酶原时间（ACT）＞300 s.常规取左乳内动脉及下肢大隐静脉备作搭桥血管.远端吻合口吻合时,采取心脏与心包之间垫湿纱布,心脏表面稳定器（MEDOS）固定.大部分病例心脏表面固定为非吸附性固定.在远端各吻合口吻合时,均应用冠状动脉内分流栓（inshunt）.本组61例首先完成左乳内动脉（LIMA）至LAD的血流重建.结果 全组围手术期无死亡.术后房颤24例、室性心律失常6例、室上性心动过速2例、心功能不全5例、二次开胸2例,伤口均一期愈合.无围手术期心肌梗死、血栓栓塞及神经系统并发症.术后随访1～52个月,平均26个月,除2例患者分别与术后3个月和6个月发生心肌再梗死,其中1例死于泵衰竭外,其余患者均恢复顺利.结论 OPCAB对于许多高龄（≥70岁）、心功能低下（EF＜40%）、肝肾功能不良、升主动脉钙化、有出血倾向、卒中后遗症等体外循环的高危患者,也可取得满意的治疗效果.OPCAB手术成功率在于高度重视围手术期的处理.

The clinical of beating heart coronary artery bypass grafting analysis of 64 cases

Objective To summary the clinical experiences of off-pump coronary artery bypass grafting （OPCAB）. Methods There were 64 cases of off-pump coronary artery bypass grafting from July 2007 to November 2011. All patients accepted tracheal intubation anesthesia and continuous monitoring of invasive pulse pressure movement. Vasoactive drugs were infusion by the micro-pump. Activated thromboplastin time part （ACT） was maintained〉300 s by infusion heparin. The left internal mammary artery and conventional saphenous vein were prepared as bypass vessels. When anastomosis the distal end of the vessels, wet gauze was pad between the heart and pericardium, and the heart of the surface stabilizer （MEDOS） was fixed. Surface f＇rx of the heart in most cases was non-absorption. Intracoronary shunt was applied when anastomosis the distal end. The flow reconstruction of left internal mammary artery （LIMA） to LAD blood was first completed in 61 patients. Results No perioperative mortality; postoperative atrial fibrillation was in 24 cases, 6 cases of ventricular arrhythmia, supraventricular tachycardia in 2 cases and heart failure in 5 cases. Second thoracotomy for the wound healed in 2 cases. No peri- operative myocardial infarction, thromboembolism, and neurological complications. Patients were followed up 1 to 52 months, an average of 26 months, except 2 patients occurred of myocardial infarction after 3 months and 6 months respectively and one of the patient died of pump failure, the remaining patients recovered smoothly. Con- dusion Off-pump coronary artery bypass grafting （OPCAB） was applied in many elderly （≥70 years）, cardiac dysfunction （EF〈40%）, liver and kidney dysfunction, aortic calcification, bleeding tendency and stroke who were at high risk of cardiopulmonary bypass and achieved satisfactory therapeutic effects. Perioperative treatment was very important for increasing the success rate of OPCAB surgery.