【摘要】 目的总结17年成人冠状动脉旁路移植术(CABG)的临床经验。方法自1987年4月至2004年5月,共施行CABG 253例,其中217例行体外循环(CPB)CABG,10例升主动脉壁钙化的患者行升主动脉壁Gore-Tex人工血管片部分置换,以供旁路移植血管近端吻合;行非体外循环冠状动脉旁路移植术(OPCAB)30例,不降温、体外并行循环心脏不停跳下手术6例。同期行心瓣膜手术15例,左心房粘液瘤摘除术1例,室壁瘤切除术10例。结果本组住院死亡20例(7.9%,20/253)。前10年死亡率(16.0%,8/50)显著高于近7年的死亡率(5.9%,12/203;χ2=5.62,P<0.05)。死亡原因包括:心瓣膜置换术后发生低心排血量行急诊CABG,仍然无法脱离CPB 3例,多器官功能衰竭2例,关胸时发生心室颤动再次在CPB下增加旁路血管移植支数仍无效3例,发生严重肺部感染、呼吸功能衰竭导致多器官功能衰竭6例,术后发生严重室性心律失常抢救无效2例,急性肾功能衰竭4例。随访157例(67.4%,157/233),随访时间6个月-15年,远期死亡3例,死亡原因不明;大多数患者心功能和生活质量明显改善,心功能(NYHA)级87例,级49例,级16例,级2例。结论随着手术和术后治疗经验的成熟,CABG已成为治疗冠心病患者较为安全、可靠的治疗方法;Gore-Tex血管片部分置换钙化的升主动脉壁为旁路移植血管的近端吻合提供了新的方法。更多还原

【Abstract】 Objective To summarize the 17-year clinical experience of coronary artery bypass grafting(CABG).Methods From April 1987 to May 2004,total 253 patients with coronary artery disease underwent CABG.The operation were performed in 217 patients under cardiopulmonary bypass(CPB) with moderate hypothermia,because of calcified ascending aorta,partial replacement of ascending aorta wall with a piece of Gore-Tex graft for the proximal anastomosis were done in 10 patients.Off-pump coronary artery bypass grafting(OPCAB) were performed in 30 patients.The operation under CPB with heart beating were performed in 6 patients.Cardiac valvular operations were performed in 15 patients.Left atrium myxoma operation was performed in 1 patient.Left ventricular aneurysm plasty operation were performed in 10 patients.Results Total mortality rate was 7.9%(20/253).There was significant difference between the mortality rate of the first 10 years(16.0%,8/50) and that of the last 7 years(5.9%,12/203;χ2=5.62,P<0.05).The causes of death were: 3 patients died on table because of low cardiac output after valvular replacement though emergent CABG were conducted,2 patients died of multiple organ failure after valvular replacement and emergent CABG had undergone,3 patients died of ventricular fibrillation during closing the sternum,6 patients died of multiple organ failure caused of severe lung infection,2 patients died of ventricular fibrillation after operation,and 4 patients died of acute renal failure.One hundred and fiftyseven patients(67.4%,157/233) were followed up,follow-up time was 6 months to 15 years.Three of them died of unknown causes,most of them have improved life quality.There were 87 patients in New York Heart Association(NYHA) class Ⅰ,49 patients in NYHA class Ⅱ,16 patients in NYHA classⅢ,and 2 patients in NYHA classⅣ.Conclusion When the experience of surgery and postoperative care is matured,CABG is a safe method for treatment of coronary artery disease.Partial replacement of ascending aorta wall with Gore-Tex graft for proximal anastomosis of the graft is a candidate method for the treatment of patients with calcified ascending aorta.更多还原