冠状动脉旁路移植术出入液量对比分析.docVIP

冠状动脉旁路移植术出入液量对比分析 　 作者：任崇雷，高长青，肖苍松 【摘要】 目的分析非体外循环下冠状动脉旁路移植术（OPCAB）和体外循环下冠状动脉旁路移植术（CCABG）术式出入液量的变化，总结术后处理经验。方法回顾性分析并比较解放军总医院2005年6月至2005年10月连续44例OPCAB及17例CCABG手术临床资料,以同期28例体外循环（extracorporeal circulation，ECC）下成人心脏手术作对照，重点统计手术后出入液量的变化。 结果OPCAB组术中出血量明显少于CCABG组，与ECC组相当；术后引流液量与CCABG无明显差别；OPCAB组术后输血率明显少于CCABG组。OPCAB组术中入液量明显少于CCABG组及ECC组，而术后当天及第一天入液量均多于CCABG组及ECC组。OPCAB组术中、术后当天出液量明显少于CCABG组及ECC组，而术后第1、2、3天出液量与CCABG组相当，而多于ECC组。各组手术均无死亡病例，无严重并发症。结论OPCABG与CCABG相比，减少了术中出血，降低了术后输血率，从而避免了异体输血的风险；同时术后不需要刻意利尿及补液，在出入液量管理方面有着不同于CCABG的特点。 【关键词】 冠状动脉分流术；术后处理 　　Analysis of Fluid Input and Output of Coronary Artery Bypass Grafting 　　Abstract: OBJECTIVETo analyze and compare postoperative fluid input and output between off-pump and on-pump coronary artery bypass grafting (CABG) to summarize the experience of postoperative management. METHODSFrom June to October of 2005,44 cases of off-pump coronary bypass (OPCAB) and 17 cases of conventional CABG (CCABG) were retrospectively studied,and 28cases of other adult cardiac operation with extracorporeal circulation（ECC）were control group. RESULTSThe intraoperative blood losses of OPCAB were significantly lower than that of CCABG,and equal with that of ECC. The postoperative drainages were no significant differences between OPCAB and CCABG. The ratio of blood transfusions of OPCAB was significantly lower than CCABG. The fluid input of OPCAB in operative period was less than that of CCABG and ECC,which in that postoperative day and the first postoperative day were more than that of CCABG and ECC.The fluid output of OPCAB in operative period and in that postoperative day were significantly less than that of CCABG and ECC,which in the first,second and third operative day were no differences with that of CCABG and more than that of ECC. No death and mortal complication occurred in all patients. CONCLUSIONOPCAB can reduce the intraoperative blood loss and decrease the ratio of postoperative blood transfusions,and then can avoid the risk of allogenic