摘要
目的:总结分析82例射血分数<40%的冠心病患者进行的非体外循环冠状动脉旁路移植术。方法:2002年7月至2012年1月进行的选择性OPCAB手术82例,全部经左心室造影测定射血分数在25%～40%之间,平均(35.2±4.8)%。合并心肌梗死史52例,急性心肌梗死后1个月内6例,不稳定心绞痛24例。心功能Ⅱ级18例,Ⅲ级56例,Ⅳ级8例。冠状动脉造影提示2支病变11例,3支病变53例,左主干18例。结果:全部病例均完成OPCAB手术,平均远端吻合口数目为(2.9±0.8)个,使用主动脉内球囊反搏14例,其中7例在手术中安放。死亡3例,均为术后围术期心肌梗死死亡。有6例术后出现急性左心衰,安放主动脉内球囊反搏后保守治疗好转。其中3例心室颤动,均复苏成功。18例行围术期CCO(持续心排血量)监测,术前CO指数在1.8～3.8之间,平均2.4±0.46,术后第1天CO指数在3.6～7.2之间,平均4.8±1.26。结论:严重心功能减退患者实施OPCAB手术有良好的可行性和近期效果,而长期结果仍有待进一步观察。
Objective：To evaluate the effects of off-pump coronary artery bypass grafting（OPCAB） in 82 patients with poor heart function（EF〈40%）.Methods：From July 2002 to January 2012,82 patients underwent selective off pump coronary artery bypass grafting.Left ventricular ejection fraction measured with ventricular angiography was（35.2±4.8）%（25%-40%）.52 cases had a history of myocardial infarction,including 6 cases with acute myocardial infarction and 24 cases with unstable angina pectoris.The heart function was Ⅱ,Ⅲ and IV in 18,56 and 8 cases,respectively.Coronary angiography demonstrated two-vessel disease in 11 cases,three-vessel disease in 53 cases,and left main coronary disease in 18 cases.Results：All patients received OPCAB surgery with 2.9±0.8 distal anastomoses.Intra-aortic balloon pump（IABP） was used in 14 cases,including IABP was inserted in 7 cases during operations.Three patients died of perioperative myocardial infarction after surgery.Acute left heart failure occurred in 6 cases and ventricular fibrillation in 3 cases,they recovered with proper treatment.In 18 cases,CO index was 2.4±0.46（1.8-3.8） before operation,and it increased to 4.8±1.26（3.6-7.2） on the first day after operation.Conclusion：OPCAB is a feasible and effective treatment in patients with poor heart function.However,the long-term effect needs to be further followed-up.
出处
《心肺血管病杂志》
CAS
2012年第6期643-645,共3页
Journal of Cardiovascular and Pulmonary Diseases
