摘要
目的探讨冠状动脉慢性完全闭塞病变的外科手术方法及临床体会。评价冠状动脉造影在冠状动脉慢性完全闭塞病变诊断中的价值。方法753例928支冠状动脉慢性完全闭塞病变（其中冠状动脉造影无逆显影148支。有逆显影780支）患者行冠状动脉搭桥术（术前冠状动脉造影无逆显影的冠状动脉慢性完全闭塞病变术中有31支有血流，而有逆显影的冠状动脉慢性完全闭塞病变中有75支无血流），搭桥根数2501根。其中152例患者行内膜剥脱后冠状动脉搭桥155支，37例患者行心中静脉原位静脉动脉化37支。术中736例在非体外循环下完成手术，17例因血流动力学不稳定，由非体外改为体外循环下冠状动脉搭桥术，其中8例安放主动脉内球囊反搏，术后8例应用了连续性静脉—静脉血液透析滤过。结果术中无死亡病例。152例行内膜剥脱后冠状动脉搭桥患者术后死亡2例，其中1例死于严重低心排出量，1例死于肾功能衰竭，另150例患者随访1月-9年，术后2年猝死1例，心绞痛症状均消失132例（88．6％），心绞痛症状缓解14例（9．4％），NYHA心功能分级Ⅰ-Ⅱ级；其余601例术后住院期间死亡5例，其中1例死于严重低心排出量，2例死于肾功能衰竭，1例死于围术期心肌梗死，1例死于脑血管意外。术后随访心绞痛缓解率99％，心功能恢复。结论冠状动脉慢性完全闭塞病变患者采用冠状动脉搭桥术可以取得良好的效果，如果可能尽量采取非体外循环技术。及时应用主动脉内球囊反搏及连续性静脉—静脉血液透析滤过可以改善危重患者的预后。冠状动脉造影在评价冠状动脉完全闭塞上有一定的局限性，冠状动脉血管内视镜技术和血管内超声可以协助诊断。
Aim To investigate the surgical therapy for chronic total occlusion of coronary artery, Methods 753 patients with 928 totally occluded coronary arteries （ 148 coronary arteries lack of opacification while the other 780 arteries with reverse flow） underwent coronary artery bypass grafting （CABG）. A total of 2501 grafts were constructed including 155 placed to coronary endarterectomy （CE） targets and 37 arterialized middle cardiac veins. Blood flow was detected during operation in 31 coronary arteries with no opacification in preoperative angiography, while no blood flow was detected in 75 coronary arteries with opacification in preoperative angiography. Cardiopulmonary bypass was applied in 17 cases because of a poor hemodynamics and 8 of which were assisted with IABP. The other 736 cases underwent OPCAB. CVVHDF was performed for 8 cases. Resuits All patients survived the operation. In the 152 cases of coronary endarterectomy, 2 died after operation because of low cardiac output （1 case） and renal failure （1 case）. The other 150 cases were followed up for 1 month to 9 years. One died suddenly 2 years after operation. Angina disappeared completely in 132 cases （88.6% ） and 14 patients relieved from angina with NYHA function ofstage Ⅰ-Ⅱ . For the other601 patients, 5 died in hospital because oflow cardiac output （1 case）, renal failure （1 case）, perioperative cardiac infarction （ 1 case） and cerebrovascular accident （ 1 case）. Recovery of cardiac function and freedom from cardiac angina was 99%. Conclusions CABG can be well preferred in patients with total occlusion of coronary arteries. The application of IABP and CVVHDF can improve the prognosis of severe case. It is limited to evaluate totally occluded coronary artery only using coronary angiography, and endoscope or intravascular ultrasound techniques may be helpful.
出处
《中国动脉硬化杂志》
CAS
CSCD
2008年第6期483-486,共4页
Chinese Journal of Arteriosclerosis
基金
辽宁省科学技术计划项目(2006401013-2)
关键词
外科学
冠状动脉慢性完全闭塞
体外循环
冠状动脉搭桥术
Chronic Total Occlusion of Coronary Artery
Extracorporeal Circulation
Coronary Artery Bypass Grafting
