南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2014年
5期
679-682
,共4页
肖苍松%王嵘%李伯君%吴扬%王刚%任崇雷%叶卫华%盛炜%李佳春%王加利%陈婷婷%周琪%张涛%马兰%高长青
肖蒼鬆%王嶸%李伯君%吳颺%王剛%任崇雷%葉衛華%盛煒%李佳春%王加利%陳婷婷%週琪%張濤%馬蘭%高長青
초창송%왕영%리백군%오양%왕강%임숭뢰%협위화%성위%리가춘%왕가리%진정정%주기%장도%마란%고장청
急诊冠状动脉旁路移植术%急性冠脉综合征%心源性休克%心力衰竭%随访
急診冠狀動脈徬路移植術%急性冠脈綜閤徵%心源性休剋%心力衰竭%隨訪
급진관상동맥방로이식술%급성관맥종합정%심원성휴극%심력쇠갈%수방
emergency coronary artery bypass grafting%acute coronary syndrome%cardiogenic shock%heart failure%follow-up
目的：总结急诊冠状动脉旁路移植手术（ECABG）治疗急性冠脉综合征的经验及中期随访结果。方法 ECABG共45例。手术指征包括急性心梗（AMI）后心源性休克（5例）、急性左心衰（6例）及药物难以控制的心绞痛（34例）。20例AMI1周内手术，术前使用主动脉气囊反搏（IABP）18例。均为三支血管病变，左主干病变15例。两次以上心肌梗死10例，慢性肾功能不全6例，其中2例须血液透析。全部在体外循环（CPB）心脏停跳下手术。左乳内动脉（LIMA）与前降支（LAD）吻合，大隐静脉（GSV）与其它靶血管吻合。采用顺灌加静脉桥灌冷血停跳液或HTK液保护心肌。CPB时间104.2±29.7 min，阻断升主动脉69.0±21.3 min。左乳内动脉（LIMA）使用率100%，平均搭桥2.9±0.6支。结果痊愈出院41例，住院死亡4例（8.9%），其中与心脏相关死亡1例（2.2%）。术前放置IABP者除1例死于MOSF外，余者术后25.5±9.7 h停用IABP。随访到38例，随访率92.7%，随访时间平均37.3±16.7月，随访期间死亡2例，生存率94.7%。心功能（NYHA）Ⅰ级和Ⅱ级共35例（92.1%），心血管事件免除率90.5%。随访超声心动图，左室前后径（43.4±5.4 mm）较术前（48.5±5.5 mm）缩小（P<0.05）；左室射血分数（LVEF）（55.7%±8.9%）与术前（43.5%±9.6%）显著改善（P<0.05）。冠脉CTA评价LIMA桥血管通畅率为95.8%，GSV通畅率为90.5%。结论尽管ECABG风险高，但如果手术指征和时机选择得当，围术期处理完善，心脏相关死亡率虽有所增加，但近中期生存率、心血管事件免除率和心功能等结果良好。
目的：總結急診冠狀動脈徬路移植手術（ECABG）治療急性冠脈綜閤徵的經驗及中期隨訪結果。方法 ECABG共45例。手術指徵包括急性心梗（AMI）後心源性休剋（5例）、急性左心衰（6例）及藥物難以控製的心絞痛（34例）。20例AMI1週內手術，術前使用主動脈氣囊反搏（IABP）18例。均為三支血管病變，左主榦病變15例。兩次以上心肌梗死10例，慢性腎功能不全6例，其中2例鬚血液透析。全部在體外循環（CPB）心髒停跳下手術。左乳內動脈（LIMA）與前降支（LAD）吻閤，大隱靜脈（GSV）與其它靶血管吻閤。採用順灌加靜脈橋灌冷血停跳液或HTK液保護心肌。CPB時間104.2±29.7 min，阻斷升主動脈69.0±21.3 min。左乳內動脈（LIMA）使用率100%，平均搭橋2.9±0.6支。結果痊愈齣院41例，住院死亡4例（8.9%），其中與心髒相關死亡1例（2.2%）。術前放置IABP者除1例死于MOSF外，餘者術後25.5±9.7 h停用IABP。隨訪到38例，隨訪率92.7%，隨訪時間平均37.3±16.7月，隨訪期間死亡2例，生存率94.7%。心功能（NYHA）Ⅰ級和Ⅱ級共35例（92.1%），心血管事件免除率90.5%。隨訪超聲心動圖，左室前後徑（43.4±5.4 mm）較術前（48.5±5.5 mm）縮小（P<0.05）；左室射血分數（LVEF）（55.7%±8.9%）與術前（43.5%±9.6%）顯著改善（P<0.05）。冠脈CTA評價LIMA橋血管通暢率為95.8%，GSV通暢率為90.5%。結論儘管ECABG風險高，但如果手術指徵和時機選擇得噹，圍術期處理完善，心髒相關死亡率雖有所增加，但近中期生存率、心血管事件免除率和心功能等結果良好。
목적：총결급진관상동맥방로이식수술（ECABG）치료급성관맥종합정적경험급중기수방결과。방법 ECABG공45례。수술지정포괄급성심경（AMI）후심원성휴극（5례）、급성좌심쇠（6례）급약물난이공제적심교통（34례）。20례AMI1주내수술，술전사용주동맥기낭반박（IABP）18례。균위삼지혈관병변，좌주간병변15례。량차이상심기경사10례，만성신공능불전6례，기중2례수혈액투석。전부재체외순배（CPB）심장정도하수술。좌유내동맥（LIMA）여전강지（LAD）문합，대은정맥（GSV）여기타파혈관문합。채용순관가정맥교관랭혈정도액혹HTK액보호심기。CPB시간104.2±29.7 min，조단승주동맥69.0±21.3 min。좌유내동맥（LIMA）사용솔100%，평균탑교2.9±0.6지。결과전유출원41례，주원사망4례（8.9%），기중여심장상관사망1례（2.2%）。술전방치IABP자제1례사우MOSF외，여자술후25.5±9.7 h정용IABP。수방도38례，수방솔92.7%，수방시간평균37.3±16.7월，수방기간사망2례，생존솔94.7%。심공능（NYHA）Ⅰ급화Ⅱ급공35례（92.1%），심혈관사건면제솔90.5%。수방초성심동도，좌실전후경（43.4±5.4 mm）교술전（48.5±5.5 mm）축소（P<0.05）；좌실사혈분수（LVEF）（55.7%±8.9%）여술전（43.5%±9.6%）현저개선（P<0.05）。관맥CTA평개LIMA교혈관통창솔위95.8%，GSV통창솔위90.5%。결론진관ECABG풍험고，단여과수술지정화시궤선택득당，위술기처리완선，심장상관사망솔수유소증가，단근중기생존솔、심혈관사건면제솔화심공능등결과량호。
Objective To summarize the experience with emergency coronary artery bypass grafting (ECABG) for management of acute coronary syndrome and analyze the mid-term follow-up results. Methods Forty-five ECABG surgeries were performed in 34 male and 11 female patients (aged 65.6±5.8 years) for cardiogenic shock (5 cases), acute heart failure (6 cases) and refractory unstable angina (34 cases). Twenty patients received the operation within one week after acute myocardial infarction (AMI) and 18 were preoperatively supported by intra-aortic balloon pumping (IABP). All patients had triple-vessel disease and 15 had left main stenosis. Ten patients experienced two myocardial infarctions and 6 had chronic renal dysfunction including two requiring hemodialysis. On-pump operations were performed in all cases with a mean CPB time of 104.2 ± 29.7 min and cross clamping time of 69.0 ± 21.3 min. Cold blood or HTK cardioplegia was used for myocardial protection. The left internal mammary artery (LIMA) was routinely anastomosed to the left anterior descending artery (LAD), and the great saphenous vein (GSV) to other target vessels. The mean number of grafts was 2.9±0.6. Results Forty-one patients were cured and discharged and 4 patients died with an in-hospital mortality of 8.9%, including one associated with cardiac event (2.2%). IABP was weaned off within 28.5 ± 10.6 h after surgery except for one patient who died of multiple organ and system failure (MOSF). Thirty-eight patients (92.7%) were followed up for a mean of 37.3 ± 16.7 months, during which 2 patients died with a mid-term survival rate of 94.7%. Thirty-five (92.1%) patients had New York Heart Association (NYHA) class I and II. The freedom from cardiac event was 90.5%. Follow-up echocardiography showed significantly improved left ventricular dimension and ejection fraction in these cases (P<0.05), and graft patency was 95.8%for the LIMA and 90.5%for the GSV. Conclusion Despite a slight increase of the in-hospital mortality, ECABG can improve the mid-term survival, freedom from cardiac event, and cardiac function when the indications and timing for surgery are well controlled with optimal perioperative management.
