摘要
目的 探讨冠状动脉旁路移植术 (CABG)术后出现围术期心肌缺血 (PMI)的相关危险因素及其处理措施。 方法 回顾性总结 2 6 80例 CABG患者的临床资料 ,并根据术后是否发生 PMI将其分为 PMI组 (30例 )和非PMI组 (2 6 5 0例 ) ,分析 CABG后出现 PMI的危险因素。 结果 PMI组中 11例进行急诊再血管化 ,其余行主动脉内球囊反搏 (IABP)或药物治疗 ;院内死亡 7例 ,死亡率为 2 3.3%。心绞痛症状缓解 2 2例 ,心电图完全或部分复原 9例 ,残留心肌梗死改变 14例。非 PMI组院内死亡 5 8例 ,死亡率为 2 .2 %。两组死亡率之间比较差别具有显著性意义(χ2 =5 6 .0 4 ,P=0 .0 0 1)。多因素分析表明 ,术前无心肌梗死史、冠状动脉弥漫性病变和术中内膜剥脱为相关危险因素。结论 PMI是 CABG术后一种比较危险的并发症 ,严重者可危及生命 ,及早诊断和适当的治疗尤为重要 ,对于因旁路血管堵塞造成的 PMI,急诊再次血管移植是挽救患者生命的必要措施。
ObjectiveTo assess the diagnosis and treatment of perioperative myocardial ischemia (PMI) after coronary artery bypass grafting (CABG). MethodsThe clinical data of 2 680 CABG patients were reviewed, and were divided into two groups, PMI group (n=30) and no PMI group (n=2 650). Using multivariate analysis, the risk factors of mortality and morbidity were detected.ResultsIn PMI group, 11 patients underwent coronary reoperation and others were treated with intra-aortic balloon counterpulsation (IABP) and medicine. Seven patients died in the hospital, the mortality was 23.3%, in which was 2.2% in no PMI group (χ2=56.04,P=0.001). No infarction history, extensive coronary artery disease and endarterectomy were independent risk factors in multivariate analysis. ConclusionsPMI is a severe complication after CABG. Early diagnosis and treatment is important. Coronary reoperation should be used promptly.
出处
《中国胸心血管外科临床杂志》
CAS
2002年第4期237-239,共3页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
冠状动脉旁路移植术
围术期
心肌缺血
Coronary artery bypass grafting
Perioperative myocardial ischemia
Reoperation
