医药学论文：非体外循环冠状动脉搭桥术在低射血分数病人中的应用

[关键词] 冠状动脉搭桥术，非体外循环，左室功能低下，射血分数
 

　　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25.6±5.6%。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3.9±0.8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 Grafting

　　in Patients with Low Ejection Fraction

　　Wan Feng. Chen Yu, Wang Jingsheng, Wang Xinsheng, Chen Shenglong

　　Abstract

　　Objective: To analyze 25-case off-pump coronary artery bypass grafting （OPCAB） 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 25.6±5.6%。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.

　　Results：OPCAB surgery were performed in all the cases. The mean number of distal anastamose was 3.9±0.8. 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.