CAJ | 학술논문

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7～36 h。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。
목적총결관상동맥좌주간엄중협착（LMS）적외과치료효과화림상경험。방법행관상동맥방로이식술（CABG）적LMS환자257례，남성161례，녀성96례，년령（63．4±2．3）세（54～76세），기중좌심실사혈분수≤30％55례。급진수술5례，술후방치주동맥구낭반박（IABP）12례。103례재상규체외순배심장정도혹자체외순배보조심장도동혹심실전동하완성수술；152례응용비체외순배심장불정도기술，술중개위체외순배7례。결과257례중，공행원단문합구681개，술후호흡궤보조7～36 h。술후출현일과성정신증상24례（비체외순배자6례，체외순배자18례）；술후출현엄중저심수출량종합정혹위수술기심기경사행IABP지지15례。폐부병발증27례；사망7례，사인위호흡쇠갈2례、위술기급성심기경사2례、엄중저심수출량종합정3례；기타환자균전유출원。결론진관LMS시예시CABG술후사망솔적독립위험인소，단CABG잉시치료LMS적제일선택，차시안전、유효적방법。
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 .4 years . The left ventricular ejection fraction was ≤30% in 55 patients . Emergency surgical revascularization was performed in 5 patients 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) ,7 of whom were converted to CPB . Results The number of bypass grafts was 681 . The time of intubation was 7~36 h . The early post‐operative complication included:24 with complication of central nervous system ;15 patients supported with IABP for severe low cardiac output syndrome or myocardial infarction postoperatively . 27 were with pulmonary complications . There were 7 postoperative death :2 with respiratory failure ,2 with periopera‐tive myocardial infarction ,3 with severe low cardiac output syndrome . Conclusion The presence of left main stenosis is an independent risk factor for coronary bypass grafting's postoperative mortality ,nonethe‐less CABG is the first choice for such patients and is safe and effective .