中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

影响不停跳冠状动脉旁路移植术效果的因素探讨

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目的 探讨影响不停跳冠状动脉搭桥手术的因素,提高不停跳手术的效果。 方法 回顾性分析 2012 年 1 月到 2016 年 6 月,吉林大学第二医院心血管外科收治的 898 例冠心病患者,均单纯行冠状动脉旁路移植术,所有患者均在心脏不停跳下进行搭桥。其中非体外循环心脏不停跳下冠状动脉旁路移植术(off-pump coronary-artery bypass grafting,OPCABG)组 797 例,其中男 592 例、女 205 例,平均年龄 60.5 岁;体外循环心脏不停跳下冠状动脉旁路移植术(off-pump beating heart coronary-artery bypass grafting,OPBH)组 101 例,其中男 77 例、女 24 例,平均年龄 61.5 岁。 结果 OPCABG 组患者平均搭桥数(3.36±0.74)支。OPBH 组患者平均搭桥数(3.71±0.69)支,二者无明显差异。术后呼吸机辅助通气时间,ICU 时间,住院时间,死亡率,IABP 使用率,ECMO 使用率有明显差异。全部 898 例总体死亡率为 12 例,总体无输血率为 91.3%。 结论 研究结果显示,通过心尖及心肌固定器的引入、手术技术和方法的改进、良好的麻醉管理、血管活性药物的灵活精确运用,绝大多数手术患者取得良好效果,但对于那些心脏显著扩大,心功能差,术中搬运心脏导致循环不稳定的患者,需要体外循环的引入。

Objective To explore the factors affecting the operation of coronary artery bypass grafting and improve the effect of the operation. Methods from January 2012 to June 2016, 898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively. All patients underwent coronary artery bypass grafting only. All patients were cabled under beating heart. The off-pump coronary artery bypass grafting (off-pump coronary-artery bypass grafting, OPCABG) group concluded 797 patientss; Another 101 patientss were beating heart coronary artery bypass grafting (on-pump beating heart coronary-artery bypass grafting, OPBH) group. Results the average number of bypasses in group OPCABG were 3.36±0.74. And the group OPBH were 3.71±0.69, and there was no significant difference between them. The postoperative ventilator ventilation time, ICU time, hospitalization time, mortality, the utilization rate of IABP and ECMO were significantly different. The total mortality of all 898 patientss was 1.68% (14 patientss), and the total bloodless operation ratio was 91.3%. Conclusion the results showed that most patients achieved good results with the help ofapical fixation and myocardial fixator, surgical techniques and methods, good anesthesia management, flexible and accurate use of vasoactive drugs. But extracorporeal circuIation are necessary in the patientss of large left ventricle, low EF and hypotension after moving heart.

关键词: 非体外循环心脏不停下跳冠状动脉旁路移植术; 体外循环心脏不停跳下冠状动脉旁路移植术; 冠状动脉旁路移植术

Key words: off-pump coronary-artery bypass grafting; on-pump beating heart coronary-artery bypass grafting; coronary-artery bypass grafting

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