摘要
目的评估跨狭窄补片行冠脉重建并搭桥技术治疗弥漫性冠脉病变的近期疗效。方法 2012年1月-2014年2月在解放军总医院采用跨狭窄补片行冠脉重建并搭桥(冠脉重建组)的患者26例,以同期行单纯常规冠脉搭桥(常规搭桥组)的120例患者作为对照,两组体外循环、心肌保护及围术期处理相同。对比观察两组的搭桥支数、体外循环时间、升主动脉阻断时间、术后心肌酶水平、病死率和并发症发生率。结果冠脉重建组左前降支切口长度为3.5±0.9cm,26例患者均痊愈出院,无围术期心肌梗死、低心排、恶性室性心律失常、二次开胸止血、中风和肾功能不全等并发症。常规搭桥组病死率0.83%。冠脉重建组的体外循环时间(112.3±20.8min)和主动脉阻断时间(96.6±21.3min)明显长于常规搭桥组(分别为97.0±29.4、67.1±20.2min,P=0.05,P=0.00),但两组桥血流量和术后肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白T水平差异无统计学意义(P>0.05)。结论对靶血管弥漫长段或多处狭窄病例,切开狭窄部位进行冠脉补片重建并搭桥,不增加手术风险,近期效果良好。
Objective To evaluate the short-term results of reconstruction and revascularization of diffuse coronary artery disease by repair with a patch across the stenosis. Methods The data of 26 patients undergoing coronary artery reconstruction and bypass graft by repair with a patch across the stenosis （reconstruction group） in General Hospital of PLA from Jan, 2012 to Feb, 2014 were retrospectively reviewed, and 120 patients undergoing conventional coronary artery bypass graft during the corresponding period （conventional group） were studied as control. The methods for cardiopulmonary bypass, myocardial preservation and perioperative management were similar in the two groups. The number of bypass grafts, cardiopulmonary bypass （CPB） time, aortic cross-clamping time, postoperative cardiac enzyme level, in-hospital mortality and incidence of complication were investigated and compared between the two groups. Results In reconstruction group, the mean length of the arteriotomy incision of the left anterior descending artery （LAD） was 3.5±0.9 cm, all patients recovered well, and no major postoperative complications, such as perioperative myocardial infarction, low cardiac output syndrome, malignant ventricular arrhythmia, re-exploration for bleeding, cerebral vascular accident and renal failure, were found. The postoperative mortality was 0.83% in conventional group. The cardiopulmonary bypass time and aortic cross-clamping time of reconstruction group （112.3±20.8 min and 96.6±21.3 min, respectively） were longer than those of conventional group （97.0±29.4 min, 67.1±20.2 min, P=0.04, P=0.00）, while the levels of postoperative cardiac enzyme CK-MB and troponin T were similar in the two groups. Conclusion Coronary artery reconstruction and bypass graft by repair with a patch across the stenosis could be performed safely in diffuse coronary artery disease patients, and the short-term outcome is encouraging.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2014年第5期396-400,共5页
Medical Journal of Chinese People's Liberation Army
