摘要
目的:探讨非体外循环冠状动脉搭桥术治疗冠状动脉介入术后再狭窄的临床应用及效果。方法:回顾性分析我院心外科自2008年7月至2009年6月对109例冠状动脉介入术后再狭窄患者实施非体外循环冠状动脉搭桥术前后的影像学资料及临床资料,总结手术方法选择和手术效果。结果:109例非体外循环冠状动脉搭桥平均远端吻合口(3.01±0.80)个,全部病例围术期无心绞痛发作,7例出现心力衰竭(心衰),无围术期死亡。全部患者出院前无心绞痛复发,活动量增加,心功能改善。结论:冠状动脉介入治疗术后再狭窄应积极实施非体外循环冠状动脉搭桥手术。
Objective：Percutaneous coronary intervention（PCI） has been widely used in treatment of coronary artery diseases.About 20%-30% patients have in-stent restenosis after percutaneous coronary intervention（PCI） within 6 months.Results of off-pump coronary artery bypass grafting（OPCAB） for the treatment of patients with in-stent restenosis was reported.Methods：From Jul.2008 to Jun.2009,109 patients with in-stent restenosis received OPCAB in our hospital.Clinical data including coronary angiography pre and post operation was reviewed in each patient.The mean age was（60.17 ± 10.04）years（range 38 to 81 years）.Eighty-eight were male and 21 female.The mean left ventricular ejection feaction（LVEF） was 58.04% ± 10.86%,NYHA I-IV.All patients received OPCAB.Saphenous vein（SV） and left internal mammary artery（LIMA） were utilized as grafts.LIMA was routinely anastomosed to the left anterior descending artery（LAD）,and SV to the other target vessels.The average number of grafting was（3.01 ± 0.80） per case.The mean operation time was（4.14 ± 0.79）hr and ICU time was（1.1 ± 0.6） d.Results：There was no operative death,perioperative myocardial infarction,liver or renal failure and other serious complication.The angina pectoris disappeared after operation in all cases.Conclusion：OPCAB is safe and effective in treatment of in-stent restenosis.OPCAB would be the first choice for treatment of in-stent restenosis.OPCAB is suitable for patients who don＇t have valve disease or left ventricular aneurysm that need to be repaired on-pump.OPCAB should be considered in patients with LVEF higher than 40%.Intra-aortic balloon pump（IABP） is helpful in patients with LVEF lower than 40%.The success rate can be raised by complete revascularization and careful perioperative monitoring.
出处
《心肺血管病杂志》
CAS
2010年第3期203-205,共3页
Journal of Cardiovascular and Pulmonary Diseases
