急诊冠状动脉搭桥术18例临床分析.docVIP

急诊冠状动脉搭桥术18例临床分析 【摘要】 ［背景］ 探讨急诊冠状动脉搭桥术（CABG）的手术指征及外科处理要点，提高手术成功率. ［病理报告］ 18例急诊CABG病人中术前急性心肌梗死者为8例,不能控制的不稳定型心绞痛者为7例，冠状动脉造影术和经皮腔内冠状动脉成形术时发生右冠状动脉撕裂、急性心包压塞及心室纤颤者各为1例；术前放置主动脉气囊反搏泵13例.17例在体外循环下行急诊CABG，体外循环时间为（78.5±25.2）min,阻断时间为（65.3±23.6）min，每例搭桥（3.4±1.1）支；1例患者实施小切口行不停跳搭桥术.采用左乳内动脉桥者为14例，右乳内动脉桥者为1例，桡动脉桥者为6例.1例术中死亡，1例术后死于低心排出量综合征，16例随访2~25月未见明显的心绞痛及心肌缺血表现. ［讨论］ 急诊CABG是挽救不能控制的急性心肌缺血的有效 方法 之一，及时正确的抢救方法是保证手术成功的关键. 【关键词】 冠状动脉分流术;心肌梗死;急诊处理 ABSTRACT: BACKGROUND To evaluate the ways of the surgical experience of emergency coronary artery bypass grafting (CABG). CASE REPORTS Out of 18 patients with emergency CABG, 8 had acute myocardial infarction (AMI) before operation, 7 had uncontrolled unstable angina, and 2 had tearing of right coronary artery, cardiac tamponade and ventricular fibrillation at coronary angiography and percutaneous transluminal coronary anfioplasty (PTCA). Intraaortic balloon pumping (ABP) was used in 13 cases before operation. 17 cases were operated with on pump CABG, 1 was performed off pump. Average time of external circulation, aortic clamp time and operative time was (65.3±23.6) minutes, (78.5±25.2) minutes and (240.0±85.5) minutes, respectively. An average of 3.4±1.1 grafts was performed per patient. One patient died during operation, and another died due to the heart function failure after operation. 16 patients had no obvious angina pectoris and myocardial ischemia by following up 2～25 months. DISCUSSION Emergency CABG is one of effective methods for curing the uncontrolled acute myocardial ischemia, and the prompt and correct salvaging methods is very important to ensure the operation success. Key words:coronary artery bypass;myocardial infarction;emergency treatment 1 临床资料 1.1 一般资料 本组18例急诊CABG病人中，男性为15例，女性为3例；年龄为40~72岁，平均为62岁；合并糖尿病者为12例，高血压者为10例.所有患者中术前急性心肌梗死者为8例，其中广泛前壁或侧壁心肌梗死者为7例，下壁心肌梗死者为1例；7例直接行冠状动脉造影术及经皮腔内冠状动脉成形术，1例溶解血栓失败后急诊行冠状动脉造影术及经皮腔内冠状动脉成形术，但梗死相关血管均未开通；8例冠状动脉造影检查结果均提示3支血管有梗塞表现；急性心肌梗死发病至急诊CABG手术时间为（9.4±6.3）h.18例中不能控制的不稳定型心绞痛、心肌缺血及ST段明显抬高者为