非体外循环冠状动脉搭桥术在低射血分数病人中的应用

1 / 4非体外循环冠状动脉搭桥术在低射血分数病人中的应用目的：总结分析 25 例射血分数小于 30%的冠心病患者进行的非体外循环冠状动脉搭桥术。方法：2000 年 2 月至 2001 年 4 月进行的选择性 OPCAB 手术 25 例，全部经左心室造影测定射血分数在 6-30%之间，平均%。合并心梗史 19 例，急性心肌梗塞后 1 个月内 6例，不稳定心绞痛 12 例。心功能 II 级 9 例，III 级 12 例，IV 级 4 例。冠状动脉造影提示两支病变 3 例，三支病变 22例，左主干 7 例。结果：全部病例均完成 OPCAB 手术，平均远端吻合口数目为个，使用主动脉内球囊反搏 14 例，其中 10 例均在手术中安放。手术死亡 1 例，于术后 2 月死于多器官功能衰竭。有 2 例术后出现急性左心衰，安放主动脉内球囊反搏后保守治疗好转。其中 2 例为室颤，均复苏成功。结论：低射血分数患者实施 OPCAB 手术有良好的可行性和近期效果，而长期结果仍有待进一步观察。Off -Pump Coronary Artery Bypass Grafting2 / 4in Patients with Low Ejection FractionWan Feng. Chen Yu, Wang Jingsheng, Wang Xinsheng, Chen ShenglongAbstractObjective: To analyze 25-case off-pump coronary artery bypass grafting in patients with low left ventricular ejection fraction. Method：25 case selective off pump coronary artery bypass grafting from February of 2000 to April of 2001 were analyzed, whose mean left ventricular ejection fraction by ventricular angiography was %。There were 19 cases with history of myocardial infarction, 12 case with unstable angina pectoris, 22 cases with triple vessels defect and 7 cases with left main coronary defect.123 下一页3 / 4Results：OPCAB surgery were performed in all the cases. The mean number of distal anastamose was Intra-aortic balloon pump was used in 14 cases, of which 10 cases were inserted balloon in operating room. There was 1 death due to multiple system and organ failure2 months after operation. 2 cases with acute heart failure and 2 cases with ventricular fibrillation after operation were successfully rescued.Conclusion：OPCAB had good feasibility and early outcome in patients with low ejection fraction. However, the long-term outcome will be observed.Key Words: coronary artery bypass, off pump, ejection fraction, left ventricular dysfunction 严重左室功能低下被认为是冠状动脉搭桥手术的危险因素2。Benetti 等1人成功开展的非体外循环冠状动脉搭桥术避免或减少了体外循环损伤和缺血再灌注损伤，是现代微创冠脉外科的代表术式之一，对于低射血分数的病人将获益更多。然而，严重左室功能低下本身也增加了 OPCAB4 / 4手术的难度。我院从 2000 年 2 月至 2001 年 4 月对 25 例射血分数小于 30%的病人实施 OPCAB 手术治疗，效果满意，现总结分析如下：1. 资料和方法：病例资料：北京大学人民医院从 2000 年 2 月至 2001 年4 月进行的选择性 OPCAB 手术 25 例，全部经左心室造影测定射血分数在 6-30%之间，平均%。男 21 例，女 4 例，年龄在 42-75 岁之间，平均岁。合并心梗史 19 例，急性心肌梗塞后 1 个月内 6 例，不稳定心绞痛 12 例，介入治疗史3 例。心功能 II 级 9 例，III 级 12 例，IV 级 4 例