摘要
目的分析接受急诊冠状动脉旁路移植术(ECABG)患者的临床特征,总结手术特点。方法以2007年1月~2008年6月接受ECABG的18例患者作为研究对象(ECABG组),其中急性心肌梗死12例,难以纠治的不稳定心绞痛4例,介入治疗失败后手术2例。回顾分析患者术前、术中及术后的临床资料,总结手术特点。以124例同时间段的择期手术患者作为对照组。结果术前ECABG组患者心功能(NYHA分级、心排量和中心静脉压)较差,心肌梗死患者比例较高,与对照组比较差异均有统计学意义(P<0.05)。所有ECABG手术均在不停跳状态下完成,从发病到完成第一支血管再血管化时间为(7.5±1.7)h;两组的手术时间及吻合口数量差异均无统计学意义(P>0.05)。与对照组比较,ECABG组安置主动脉内球囊反搏(IABP)管道、改行体外并行循环、术后机械辅助通气时间>24h和ICU留置时间>3d的患者百分率及死亡率(22.2%vs3.2%)均明显增加(P<0.05);IABP辅助时间显著延长(P<0.05)。结论ECABG可采用不停跳技术,但死亡率仍较择期手术高,可能与患者术前心功能较差及合并急性心肌梗死有关。
Objective To analyse the clinical characteristics and surgical skills in emergency coronary artery bypass grafting (ECABG). Methods Eighteen patients with ECABG were enrolled (ECABG group),including 12 with acute myocardial infarction (AMI),4 with unstable angina and 2 with failed percutaneous transluminal coronary angioplasty.The clinicla data pre-,intra-and post-operation were retrospectively analysed. Another 124 patients for selective CABG were served as controls. Results Compared with control group,the heart function (NYHA classification,cardiac output and central venous pressure) was worse and the proportion of AMI was higher in ECABG group (P〈0.05). All the revascularizations were performed without cardiac arrest. The time from onset to first revascularization was (7.5±1.7)h. There was no significant difference in the operation time and number of anastomosis between these two groups (P〉0.05). Compared with control group,the proportions of patients with IABG,switching to paralleled cardiopulmonary bypass,with ventilation time 〉24h and with ICU stay 〉3d were larger,and the mortality (22.2% vs 3.2%) and ventilation time were significantly increased in ECABG group (P〈0.05). Conclusion ECABG can be performed without cardiac arrest,while the mortality is higher than selective operation,which may be associated with the poor heart function and presence of AMI.
出处
《上海交通大学学报(医学版)》
CAS
CSCD
北大核心
2009年第3期338-340,共3页
Journal of Shanghai Jiao tong University:Medical Science
关键词
冠状动脉旁路移植
不停跳急诊搭桥手术
非体外循环
体外并行循环
coronary artery bypass grafting
emergency coronary artery bypass grafting without cardiac arrest
off pump
paralleled cardiopulmonary bypass