冠状动脉旁路移植术的早期临床分析(附1 507例报告)

目的总结1 507例冠状动脉旁路移植术(CABG)的早期临床结果和经验.方法回顾性总结在国内15个中心完成的1 507例冠状动脉旁路移植术的临床资料,其中体外循环下手术309例,非体外循环冠状动脉旁路移植术(OPCAB)1 198例(79.5%).二次旁路移植术18例(1.2%).急诊手术144例(9.5%).合并瓣膜替换或成形术18例、室间隔穿孔手术5例、室壁瘤切除术39例、其他手术5例.1.7%的OPCAB手术需转为体外循环下完成.合并激光心肌血运重建术264例(17.5%).使用主动脉内球囊反搏83例(5.5%).结果住院死亡32例,总死亡率为2.1%,其中OPCAB手术死亡14例(1.2%).其他并发症包括:围术期心肌梗死(0.5%)、急性左心衰竭(0.3%)、严重心律失常(1.2%)、呼吸系统并发症(2.1%)、器质性神经系统并发症(1.5%)、新发或加重的肾功能不全(1.1%)、出血二次开胸(1.0%)、胸骨愈合不良(0.6%).结论不同方式下的冠状动脉旁路移植术均安全可靠,而OPCAB具备一些独特的技术特点和方法.

The early outcomes and clinical experience in coronary artery bypass grafting(report of 1 507 cases)

Objective To summarize and analyze the early outcomes and clinical experience in 1 507 patients undergone coronary artery bypass grafting(CABG) surgery.Methods This multi center report covers 15 different institutes in China.In these 1507 cases,79.5% were off pump coronary artery bypass(OPCAB), 1.2 % were redo bypass surgery,9.5% were urgent or emergent procedures.Concurrent procedures included 18 valve surgery,5 repair of ventricular septal rupture,39 resection of left ventricular aneurysm and 264 transmyocardial laser revascularization.1.7% OPCAB were converted to cardiopulmonary bypass.Results The total hospital mortality was 2.1 % and the mortality in OPCAB was 1.2 %.The morbidity included 0.5% peri operative myocardial infarction,0.3% heart failure, 1.2 % fatal arrhythmia, 2.1 % pulmonary complication,1.5% neurotic disorder,1.1% renal dysfunction, 1.0% reopen for bleeding,0.6% delayed wound cure.Conclusions CABG surgery is a safe and feasible procedure with good early results whether the pump was used or not, though OPCAB requires certain special skills and methods in practice.