【摘要】：目的:觀察"分站式"雜交冠狀動脈血運重建術(shù)(HCR)治療冠狀動脈多支血管病變中期隨訪結(jié)果,評價"分站式"HCR的可行性、安全性和療效。方法:入選2012-01至2014-06因冠狀動脈多支血管病變在我院行擇期"分站式"HCR的患者共73例,其中男性50例(68.5%),女性23例(31.5%),平均年齡(61.1±10.7)歲,所有患者均為包括左前降支在內(nèi)的多支病變。"分站式"HCR要點為:全麻雙腔氣管插管,左前胸第4或第5肋間小切口,直視下獲取左乳內(nèi)動脈,心臟跳動下完成左乳內(nèi)動脈和左前降支的吻合。在小切口冠狀動脈旁路移植術(shù)(CABG)術(shù)后3~7天,在介入導(dǎo)管室先行冠狀動脈造影,觀察左乳內(nèi)動脈-左前降支旁路血管情況,證實其通暢后對非左前降支病變行經(jīng)皮冠狀動脈介入治療(PCI)并置入支架�；颊咝g(shù)后每年進(jìn)行超聲心動圖、X線胸片和心電圖檢查,如患者出現(xiàn)心肌缺血表現(xiàn),則進(jìn)行冠狀動脈增強(qiáng)計算機(jī)斷層攝影術(shù)(CTA)或冠狀動脈造影檢查等。結(jié)果:本組患者均順利施行"分站式"HCR,全組無手術(shù)死亡。外科手術(shù)時間(152.9±43.8)min,處理冠狀動脈(2.6±0.5)支,術(shù)后總引流量(558.6±441.3)ml,輸紅細(xì)胞(0.8±1.9)U,機(jī)械通氣時間(10.5±13.0)h。小切口CABG與PCI間隔時間(5.3±2.9)d,冠狀動脈置入支架(1.6±0.7)枚。術(shù)后隨訪期間,主要不良心腦血管事件(MACCE)發(fā)生5例(6.8%),其中死亡1例(1.4%),再發(fā)心肌缺血3例(4.1%),需要接受CABG/PCI者1例(1.4%,因支架再狹窄,再次置入支架)。結(jié)論:"分站式"HCR是一種安全,有效的手術(shù)方式,其圍手術(shù)期和中期隨訪結(jié)果滿意,"分站式"HCR適合于左前降支嚴(yán)重病變無法接受PCI而右冠狀動脈主干和(或)回旋支等非左前降支病變可以進(jìn)行PCI的冠狀動脈多支病變患者。
[Abstract]:Objective: to evaluate the feasibility, safety and curative effect of "sub-station" hybrid coronary artery revascularization (HCR) in the treatment of coronary artery disease. Methods: a total of 73 patients (50 males (68.5%) and 23 females (31.5%) were enrolled in elective "sub-station" HCR from January 2012 to June 2014 in our hospital because of multi-vessel coronary artery disease, including 50 males (68.5%) and 23 females (31.5%). The mean age was (61.1 鹵10.7) years, and all patients were multivessel lesions, including left anterior descending artery. " The main points of HCR were as follows: intubation with double lumen under general anesthesia, small intercostal incision of the 4th or 5th intercostal incision of left anterior chest, obtaining left internal mammary artery directly, and anastomosis of left internal mammary artery and left anterior descending branch under beating heart. After small incision coronary artery bypass grafting (CABG), coronary angiography was performed in interventional catheterization to observe the left internal mammary artery and left anterior descending artery. After patency, percutaneous coronary intervention (PCI) and stent implantation were performed for non-left anterior descending artery lesions. The patients underwent echocardiography, chest radiography and electrocardiogram every year after operation, and coronary angiography (CTA) or coronary angiography (CAG) were performed in case of myocardial ischemia. Results: all the patients had no operative death after HCR,. The operative time was (152.9 鹵43.8) min, to treat the coronary artery (2.6 鹵0.5), the total drainage volume was (558.6 鹵441.3) ml, and the mechanical ventilation time was (10.5 鹵13.0) h. The interval between small incision CABG and PCI was (5.3 鹵2.9) days, and coronary stent placement was (1.6 鹵0.7) days. During the follow-up period, there were 5 cases (6.8%) with major adverse cardiovascular and cerebrovascular events (MACCE), 1 case (1.4%) died, 3 cases (4.1%) had recurrent myocardial ischemia, 1 case (1.4%) needed CABG/PCI. Because the stent is restenosis, place the stent again. Conclusion: the "sub-station" HCR is a safe and effective surgical method, and its perioperative and mid-term follow-up results are satisfactory. The "sub-station" HCR is suitable for patients with severe left anterior descending artery disease who cannot accept PCI, while right coronary artery trunk and / or non-left anterior descending artery disease, such as right coronary artery disease, can be performed in patients with multivessel coronary artery disease with PCI.
【作者單位】： 北京大學(xué)第三醫(yī)院心臟外科;北京大學(xué)第三醫(yī)院心臟內(nèi)科;
【分類號】：R654.2

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