论文部分内容阅读
目的 探讨脑卒中患者接受非体外循环冠状动脉旁路移植术 (OPCAB)的耐受性、安全性和临床疗效。方法 选择 2 0 0 2年 112月完成的OPCAB手术患者 2 5 9例 ,其中术前合并脑卒中 35例 (A组 ) ;非脑卒中患者2 2 4例 (B组 )分析A、B两组术前合并症、心功能分级左室射血分数、病变支数、手术及预后情况。结果 所有病例均顺利完成OPCAB手术 ,A/B组比较平均远端吻合口数目 (3.0 8± 0 .6 2 )个 / (2 .9± 0 .78)个 ;移植物乳内动脉 31/198支 ,桡动脉 14 / 10 6支 ;机械通气时间 (12 .0± 8.2 )h/ (13.0± 6 .6 )h ;第 1天引流液 (5 34± 2 2 5 )ml/ (5 11± 2 11)ml;监护时间 (5 1± 2 2 )h/ (5 6± 19)h ;输血 16 / 86例。A组低心排后多脏器功能衰竭 1例死亡 ,可逆性精神症状 1例 ,无新的脑卒中发生 ,B组住院死亡 3例 ,可逆性精神症状 3例 ,发生脑梗死 2例。使用主动脉气囊反搏 (IABP)A组 5例 ,B组 5 0例。结论 OPCAB不增加脑卒中患者冠状动脉搭桥的脑部并发症和死亡率 ,其手术安全可行 ,而且近期临床疗效满意。
Objective To investigate the tolerability, safety and clinical efficacy of off-pump coronary artery bypass grafting (OPCAB) in patients with stroke. Methods A total of 259 patients undergoing OPCAB surgery were enrolled in this study. Among them, 35 patients (group A) had preoperative OPCAB and 224 patients (group B) were non-stroke patients. Groups A and B Preoperative complications, left ventricular ejection fraction of cardiac function, lesion count, operation and prognosis. Results The OPCAB operation was successfully completed in all cases. The average number of distal anastomoses in group A / B was (3.08 ± 0.62) / (2.9 ± 0.78). The graft intraarterial arteries 31/198 Branch and radial artery 14/106, mechanical ventilation time (12.0 ± 8.2) h / (13.0 ± 6.6) h, drainage on the first day (5 34 ± 225) ml / (5 11 ± 2 11) ml; monitoring time (5 1 ± 2 2) h / (5 6 ± 19) h; blood transfusion 16/86 cases. One patient died of multiple organ failure after low cardiac output in group A, 1 patient had reversible psychiatric symptoms, no new stroke occurred, 3 died of hospitalization in group B, 3 had reversible psychiatric symptoms and 2 had cerebral infarction. Aortic balloon pump (IABP) in group A 5 cases, group B 50 cases. Conclusions OPCAB does not increase the complication rate and mortality of coronary artery bypass graft in patients with stroke. The surgery is safe and feasible, and the clinical efficacy is satisfactory in the near future.