摘要
目的 分析非体外循环冠状动脉旁路移植 (搭桥 )改为体外循环搭桥的原因和结果 ,以期提高手术成功率。方法 2 0 0 0年 1月至 2 0 0 3年 12月 ,非体外循环搭桥 (OPCAB) 195 2例 ,2 9例 (1 4 .9% )围术期发生室颤 (5例 )、低血压 (2 4例 ) ,被迫改为体外循环下搭桥 (ONCAB)。 2 6例体外循环辅助下冠状动脉旁路移植术 ,其中 8例阻断升主动脉下搭桥 ;单纯辅助循环 3例。结果 2 9例平均搭桥 (2. 9± 0. 6 )支。死亡 9例 (31. 0 3% )。术中血压≤ 80 / 4 .0mmHg(1mmHg =0 . 133kPa)者和大于此值者死亡率分别为4 7. 6 %和 8. 33% (P =0 .0 4 3) ;术中低血压持续时间 <15min者无死亡 ,≥ 15min死亡率 4 2 . 86 % (P =0 . 0 2 9)。死亡组病变血管均≥ 3支 ,且阻塞严重 ,女性死亡率高 ,死亡病例的术者行OPCAB例数均较少。结论 术中低血压的程度及持续时间与死亡密切相关。OPCAB术者经验少、病变血管 >3支者、冠脉阻塞程度严重者和女性的手术风险高 ,应严格掌握OPCAB适应证。OPCAB术中发生问题应及时处理。
Objective Analyze the causes of the conversion from off-pump coronary artery bypass (OPCAB) to on-pump coronary artery bypass grafting (ONCAB), in order to improve the operative survival rate. Methods From January 2000 to December 2003, 1952 patients underwent OPCAB. 29 patients (1.49%) required conversion from OPCAB to ONCAB. The causes of conversion included ventricular fibrillation in 5 cases, and hypotension in 24 cases. 26 patients received CABG under CPB. 8 patients under aortic cross clamping, and 3 patients needed only CPB support. Results The mean number of grafts was 2.9±0.6. 9 patients died, postoperatively with a mortality rate of 31.03%. In patients with the perioperative blood pressure lower than 80/40?mm?Hg, the mortality rate was 47.6%, and in patients with blood pressure higher than 80/40?mm?Hg, the mortality rate was 8.33% (P=0.043). No one with duration of hypotension less than 15min died, the mortality of the patients with hypotension times more than 15min was 42.86% (P=0.029). In the death group, all the patients had more than three vessel disease and severe vessel stenosis or occlusion. The mortality was hither in female patients. Conclusion Patients converting from OPCAB to ONCAB had a higher mortality. The severity and lasting time of hypotension is closely correlated with the mortality rate. The high risk factors included the surgeons with less OPCAB experience, the patients with more than three vessel diseases and severe coronary stenosis or occlusion, and female patients. The indication of OPCAB must be strictly controlled. Hypotension and severe ventricular fibrillation occurred during OPCAB must be corrected and eliminated immediately.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2005年第1期18-20,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
