全动脉化在非体外循环冠状动脉搭桥术中的应用

探讨全动脉化在非体外循环冠状动脉搭桥中的应用及效果。自2001年11月到2003年4月，运用单侧、双侧乳内动脉和桡动脉连续为29例患行冠状动脉搭桥手术，患男性22例、女性7例，年龄44～77岁(平均57．63岁)；单支病变19例，二支病变1例，三支病变7例，左主干病变2例，术前有心梗史14例，3例合并室壁瘤，均在非体外循环下行冠状动脉搭桥手术，手术方法为左侧乳内动脉(LIMA)到前降支(LAD)、右侧乳内动脉(RIMA)到右冠状动脉(RCA)、桡动脉到钝缘支(其中3例序贯至对角支)，3例搭桥4支，4例搭桥3支，3例搭桥2支，19例搭桥1支，3例同时行室壁瘤缝扎术，人均搭桥1．69支，术后无呼吸、脑、肾脏等系统的并发症，无围术期死亡；无病例需主动脉球囊反搏支持；随访患均无心绞痛再次发作，认为全动脉化在非体外循环冠状动脉搭桥中具有较好的应用效果，近期效果比较满意，远期效果尚待进一步随访。

The Application of Complete Arterial Myocardial Revascularization to Off-pump Coronary Artery Bypass Grafting

The article discussed the application of complete arterial myocardial revascularization (CAMR) to off-pump coronary artery bypass grafting (OPCAB) and its effect. From November 2001 to April 2003, 29 patients, 22 males and 7 females, received CAMR without cardiopulmonary bypass (CPB). The ages of patients ranged from 44 to 77 with an average age of 57. 63. Among these patients, 19 suffered single-vessel disease, 1 two-vessel disease, 7 three-vessel disease, 2 left main stem disease, 14 preoperative myocardial infarction and 3 combined with left ventricular aneurysm. Coronary artery bypass grafting was performed without CPB. Surgical procedure included anastomosis left internal mammary artery (IMA) to left anterior descending artery ( LAD), right IMA to right coronary artery (RCA), radial artery to obtuse marginal (sequential anastomoses for diagonal branch in 3 patients). 4 grafts were performed on 3 patients, 3 grafts on 4, 2 grafts on 3, 1 graft on 19, and 3 grafts were combined with left ventricular aneurysm suturing. The average number of grafts was 1. 69. There was no hospital mortality or severe complication after operation. Intraaortic balloon pump was not required in all patients. The following-up results showed all patients had no postoperative angina. The short-term result of CAMR without CPB is satisfying, while the long-term result needs further studies.