体外循环下心脏不停跳搭桥在严重左心功能低下患者中应用.docVIP

体外循环下心脏不停跳搭桥在严重左心功能低下患者中应用 　 作者：李燕君，苏丕雄，张云，韩薇，刘岩 【摘要】 目的 对28例严重左心功能低下患者在体外循环下行心脏不停跳搭桥（on-pump beating heart，OPBH）的应用情况进行分析总结。方法 2003年至2006年对28例择期需行冠状动脉旁路移植术（CABG）的严重左心功能低下患者施行OPBH下CABG术，其中早期左心功能低下行非体外循环搭桥（OPCAB）因血流动力学不能维持紧急转流OPBH 6例,占同期OPCAB的6/702例（0.85%），22例常规行OPBH下CABG术，分析总结OPBH在严重左心功能低下患者中的应用情况及体外循环管理经验。 结果 22例常规OPBH心脏搭桥（3.4±0.8）支，体外循环（extracorporeal circulation，ECC）时间（97.2±32.8）min，无严重并发症发生，随访2～24个月，心绞痛症状消失，心功能明显改善；紧急转流6例，搭桥（2.8±0.4）支，ECC时间（186.0±94.9）min，术中放置主动脉内球囊反搏（IABP）3例，围手术期死亡3例，分别于术后1 d、23 d、30 d死于心功能衰竭、多器官功能衰竭及急性肺栓塞。结论 对严重左心功能低下无相对ECC禁忌患者采用OPBH是一种安全可靠的手术方法，有ECC相对禁忌患者除采用基本外科技术外，宜采用“湿备”。 【关键词】 冠状动脉旁路移植术；体外循环；心脏不停跳；心功能 　　On-Pump Beating Heart CABG in Patients with Severe Left Ventricular Dysfunction 　　Abstract: OBJECTIVE To analyze the performances of the on-pump beating heart (OPBH) coronary artery bypass graft (CABG) in 28 patients with severe left ventricular dysfunction. METHODS From 2003 to 2006, 28 cases having left ventricular dysfunction undertook selective CABG with OPBH. There were 6 cases of emergent switching to extracorporeal circulation (ECC) due to unstable hemodynamic, which was 0.85% in the same period of OPCAB cases (6/702), and 22 selected cases undertook routine OPBH CABG. The procedure and the experience of the OPBH were analyzed. RESULTS In the 22 routine OPBH CABG cases, the number of grafts was (3.4±0.8), the time of ECC was (97.2±32.8) min, and no severe complications happened. The number of the grafts was (2.8±0.4), and the time of ECC was (186.0±94.9) min in the group of emergent switch, meanwhile, intra-aortic balloon pump was used in 3 cases during opertion and 3 cases died of heart failure, multi-organ failure and acute pulmonary thromboembolism after operation. CONCLUSION The reasonable application of OPBH CABG is safe and credible for patients with severe left ventricular dysfunction. 　　Key words： Coronary artery bypass grafting; Extracorporeal circulation; On-pump beating heart; Heart function 　　严重左心功能低下患者实施非体外循环搭桥（off-pum