【摘要】 目的总结冠状动脉左主干严重狭窄(LMS)的外科治疗效果和临床经验。方法行冠状动脉旁路移植术(CABG)的LMS患者257例,男性161例,女性96例,年龄(63.4±2.3)岁(54~76岁),其中左心室射血分数≤30%55例。急诊手术5例,术后放置主动脉球囊反搏(IABP)12例。103例在常规体外循环心脏停跳或者体外循环辅助心脏跳动或心室颤动下完成手术;152例应用非体外循环心脏不停跳技术,术中改为体外循环7例。结果 257例中,共行远端吻合口681个,术后呼吸机辅助7~36h。术后出现一过性精神症状24例(非体外循环者6例,体外循环者18例);术后出现严重低心输出量综合征或围手术期心肌梗死行IABP支持15例。肺部并发症27例;死亡7例,死因为呼吸衰竭2例、围术期急性心肌梗死2例、严重低心输出量综合征3例;其他患者均痊愈出院。结论尽管LMS是预示CABG术后死亡率的独立危险因素,但CABG仍是治疗LMS的第一选择,且是安全、有效的方法。更多还原

【Abstract】 Objective To summarize the surgical treatment efficacy and clinical experience in the patients with left main coronary artery stenosis. Methods A total of 257 patients with left main stenosis(LMS)underwent coronary artery bypass graft(CABG)were collected. The average age was 63.4years. The left ventricular ejection fraction was≤30%in 55 patients. Emergency surgical revascularization was performed in 5patients because of hemodynamic instability,12 patients were treated with intraaortic balloon pump(IABP)after surgery. 103 patients underwent coronary artery vascular remodeling with general extracorporeal circulation,152 were without pump(OPCAB),7of whom were converted to CPB. Results The number of bypass grafts was 681. The time of intubation was 7~36h. The early postoperative complication included:24 with complication of central nervous system;15patients supported with IABP for severe low cardiac output syndrome or myocardial infarction postoperatively. 27 were with pulmonary complications. There were 7postoperative death:2with respiratory failure,2with perioperative myocardial infarction,3with severe low cardiac output syndrome. Conclusion The presence of left main stenosis is an independent risk factor for coronary bypass grafting’s postoperative mortality,nonetheless CABG is the first choice for such patients and is safe and effective.更多还原