【摘要】 目的:讨论急诊OPCAB中动脉桥应用的指征,探讨此类手术中应用动脉桥的安全性及可行性。方法:2002年1月至2003年12月共完成急诊非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)95例,占同期OPCAB总数的21.06％。急诊手术类型:严重左主于23例(24.21％),严重三支病变71例(74.74％),顽固性心绞痛17例(17.89％),急性心肌梗死18例(18.95％),心源性休克3例(3.16％),介入并发症1例(1.05％)。常规应用乳内动脉,小于70岁患者考虑应用桡动脉,在某些特殊病例只取静脉(心功能低下,心源性休克等)。将急诊组进一步回顾性分为令静脉组(只取静脉)共25例,动脉组(乳内动脉和桡动脉)共70例。动脉组与静脉组间年龄有显著统计学差异(P<0.05)。急诊组术前合并急性心肌梗死18(18.95％)例,其中全静脉组为9(9.47％)例,动脉组9(9.47％)例(P<0.05)。陈旧性心肌梗死25(26.32％)例,其中全静脉组为6(6.32％)例,动脉组19(20.00％)例(P=1.00);不稳定心绞痛20(21.05％)例,其中全静脉组为5(5.26％)例,动脉组15(15.79％)例(P=1.00);介入PTCA后11(11.58％)例,其中全静脉组为4(4.21％)例,动脉组7(7.37％)例(P=0.47)。95例急诊患者中共有40名患者术前行超声心动检查,LVEF 20％-79％,平均(60.34±14.02)％,全静脉组与动脉组?更多还原

【Abstract】 Objective: To discuss indications for the usage of arterial grafts in emergent OPCAB and study the safety and feasibility of the application of arteries in emergent OPCAB. Methods: From January 2002 to December 2003, there were totally 95 patients undergoing emergent OPCAB. Severe left main stenosis (23 cases) , severe triple disease (71 cases) , refractory angina pectoris (37 cases) , acute myocardial infarction (14 cases) , cardiogenic shock (3 cases) and PTCA failure (1 case) were indications for e-mergent OPCAB. In the emergent group, there were 69 males and 26 females. Age ranged from 37 to 84 and averaged 63.03±11.09. According to grafts harvested, the emergent group was subdivided into group No. 1 (saphenous vein only) , group No. 2 (saphenous vein and left intra - mammary artery) and group No. 3 ( saphenous vein, radial artery and left intra - mammary artery). There were 18 patients with acute myocardial infarction preoperatively, among which 9 were in venous group ( group No. 1) and 9 in arterial group ( group No. 2 and No.3) (P<0.05). Among the 25 patients with old myocardial infarction, 6 were in venous group and 19 in arterial group (P = 1. 00) . 5 patients complaining angina pectoris were found in venous group preoperatively and 15 in arterial group ( P = 1. 00 ) . 4 cases after PTCA were assigned to venous group and 7 cases to arterial group (P = 0.47). 40 patients accepted preoperative echocardiography. The value of left ventricular ejection fraction ( LVEF) ranged from 20% to 79% and averaged 60. 34±14. 02% . Further studies revealed a significant difference of LVEF values between venous group and arterial group (P <0.05) ; no significant differences were showed among arterial group (group No. 2 and group No. 3). Results: 95 emergent patients were given OPCAB successfully. 70 left intra - mammary arteries (LIMAs) , 17 radial arteries (RAs) and 192 saphenous veins were used. Number of distal anastomosis ranged from 1 to 5 and averaged 2. 90±0. 79. 18 operations were assisted by IABP and this number revealed no significant differences (P =0. 16). The value of cardiac index (CI) ranged from 1. 80 to 6. 30 L/min/m2 and averaged 3.42±0. 87 L/min/m2; no significant differences were showed among the 95 patients but such statistic differences manifested between group No. 1 and group No. 3 ( P <0.05 ) . Intubation time averaged 19. 13±20. 83 hours ( P = 0. 14). First postoperative day’s drainage averaged 487. 84± 275.67ml (P=0.78). 1 death in venous group and 3 deaths in arterial group were noted (P = 0.78) ; perioperative myocardialinfarctions occurred in venous group with 1 case and arterial group with 3 cases respectively (P =0.60) ; rethoracotomy occurred in venous group with 1 case and arterial group with 5 cases respectively (P =0. 50) ; 1 case with respiratory failure and 1 with renal failure were reported in group No. 2; no strokes were found. Conclusions: Heart function and age are the main factors in determining whether arterial grafts can be adopted in emergent OPCAB. Indications should be strictly abided by. The above results showed that application of arterial grafts in emergent OPCAB is safe and feasible provided that the chosen indications are correct.更多还原