目的 分析高危冠心病患者接受体外循环不停搏下冠脉搭桥手术治疗的效果.方法 选取112例2016年10月-2018年10月在我院接受冠脉搭桥手术治疗的高危冠心病患者,分为试验组(n=56)和参照组(n=56),为参照组患者实施体外循环停搏冠脉搭桥术,为试验组患者实施体外循环不停搏冠脉搭桥术.结果 试验组患者死亡率为1.79％,并发症发生率为8.93％,参照组患者死亡率为12.50％,并发症发生率为17.86％,对比两组患者死亡率以及并发症总发生率差异均有统计学意义(P<0.05).结论 高危冠心病患者接受体外循环不停搏下冠脉搭桥手术治疗术后存活率明显更高且可明显减少术后并发症.

Objective To investigate the extracardiac conduit total cavopulmonary anastomosis in the treatment of complex congenital heart diseases and the operation outcomes.Methods Of the 31 patients who underwent extracardiac conduit total cavopulmonary anatomosis between May 2004 to October 2012,including 17 males and 14 females,their average age was(11.7±6.3)years,and the average body weight was(32.5±15.0)kg.Diseases including single ventricle in 10 patients,Complete endocardial cushion defect and transposition of great arteries in 10 patients,tricuspid atresia in 3 patients,double outlet right ventricle and complete endocardial cushion defect in 2 patients.Result Early postoperative death happened in 2 cases.The average follow-up period in the rest patients was 2 months-9 years,and no death occurred and their cyanosis disappeared.All patients could perform daily activities.Postoperative patients with venous pressure was significantly increased in 2 cases,1 case had pulmonary hypertension,1 case had heart pipeline calcification atresia.Conclusion Extracardiac conduit total cavopulmonary anastomosis is relatively simple,and the result of this study has shown that the early postoperative effect is good,however,the long-term effect needs further study.

<正>冠状动脉旁路移植术是目前外科治疗冠状动脉粥样硬化性心脏病最有效的方法之一,左心功能低下的患者,在行非体外循环、心脏跳动下冠状动脉旁路移植术时,往往不能耐受心脏搬动,出现低血压、心律失常,甚至室颤,有时需紧急改为体外循环辅助下完成手术。我院2010年10月至2013年4月,对

目的:探讨急诊冠脉搭桥术(Emergency coronary artery bypass grafting,ECABG)对心肌的损伤情况以及探讨H-FABP的动态变化.方法:连续性选取20例行急诊冠状动脉旁路移植术患者,患者男女不限,于术前,开心包,第一支搭桥动脉开始灌注1h、3h、6h、12h、24h;结果:20例病人肝素化前cTnI、H-FABP均处于正常范围,cTnI术后各时间点均明显升高,12h达峰值,而h-FABP在心肌损伤后血中高峰时间出现更早,24 h回复基线水平,IMA则较H-FABP灵敏度高,血中升高更早.结论:早期IMA、H-FABP测定能有效帮助临床识别急诊冠脉搭桥术,并具有急重症冠心病患者围手术期心肌损伤的早期诊断价值.

Objective:To analysis the surgical results of patients with coronary heart disease and poor left ventricular function using Off-pump coronary artery bypass grafting(OPCAB).Methods:From 2006,37 patients with poor left ventricular function underwent OPCAB,and hemodynamic parameters were analyzed retrospectively.Results:Two patients died after operation,and the mortality was 5%.One patient died of pulmonary infection,and the other died of low output syndrome.Intra-aortic balloon pump was used in 21 cases.IABP was implanted in 7 cases pre-operatively,and it was inserted in 14 cases intra-or post-operatively.37 patients Ejection fraction of left ventricle improved significantly.Left ventricular end-diastolic diameter and left ventricular end-systolic diameter decreased dramatically after surgery.Conclusion:Off-pump coronary artery bypass grafting is a useful technique for patients with poor left ventricular function.Earlier IABP implantation and inotropic agents are useful to decrease the mortality and ICU stay.