体外循环下冠状动脉搭桥术243例临床研究

Retrospective study of cardiopulmonary bypassfor coronary artery bypass graft

  • 摘要: 目的: 对我院1997年1月至2000年12月243例冠状动脉搭桥术体外循环情况进行回顾性临床研究。方法: 将患者按年度分为4组。各组均使用Stock Ⅲ型人工心肺机和膜式氧合器,升主动脉插管(22-24F)和腔房二级插管(38-42F)。4∶1含血停跳液,间断或连续灌注。比较各组患者在体外循环时间,阻断时间,转流温度,稀释度,术后呼吸机和ICU时间等方面的差异。结果: 各组患者临床资料均衡(P>0 1),有良好的可比性。1997年至2 0 0 0年体外循环时间和阻断时间有明显缩短(P<0.01),转流中的最低鼻咽温度升高(P<0.01),稀释度降低(P<0.01)。心肌保护采用顺灌、逆灌和桥灌等不同或相结合的方法,自动复苏率明显提高(P<0.01)。术后气管插管时间和ICU时间缩短(P<0.05),1例因鱼精蛋白导致过敏性休克死亡。结论: 我院冠脉搭桥术的体外循环技术不断改进,与手术密切配合已取得较好的临床效果。

     

    Abstract: Objective: To summarizing our experience of performing cardiopulmonary bypass (CPB) for coronary artery bypass graft (CABG). Methods: Retrospective analysis of 243 on-pump CABG in our hospital from January 1997 to December 2000. Four cohorts were examed 1997(n=27), 1998(n=46), 1999(n=81) and 2000(n=89). Age range was 20-75 years (mean 57.59 years). Stock-Ⅲ type of heart-lung machine, membrane oxygenator, arterial annula(22-24F) and tow-stage atrium caval cannula (34/48Fr) were used in all patients. Cardioplegia with blood 4:1 was perfused discontinuously or continuously. To compare the 4 groups in clinical data. Results: There were not significantly different among groups about clinical data (P>0.1). Compared with 1997, the ischaemic time was shortened (P<0.01), the lowest nasopharynx temperature during CPB was raised (P<0.01), the hemodilution was decreased (P<0.01) and the duration of postoperative respirator ventilation and ICU were shortened (P<0.05) in the other groups. One (0.41%)case died from allergic shock of promine. Conclusion: The on-pump for CABG has improved march in our hospital. On-pump CABG is a safe, effective method especially to those severely ill patients.

     

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