非體外循環緊急轉為體外循環冠狀動脈旁路移植術的分析_《中國胸心血管外科臨床雜志》

作者：

郭惠明 , 吳若彬 , 鄭少憶等

廣東省人民醫院廣東省心血管病研究所心外科, 廣州 510100;

關鍵詞：

非體外循環冠狀動脈旁路移植術體外循環并發癥

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目的了解導致非體外循環冠狀動脈旁路移植術（off-pump coronary artery bypass grafting, off-pump CABG）緊急轉為體外循環冠狀動脈旁路移植術(on-pump coronary artery bypass grafting, on-pump CABG)的臨床的原因，為手術方法的選擇提供借鑒。方法回顧分析2002年1月～2006年5月期間546例冠心病患者行off-pump CABG的臨床資料，對術中需緊急轉為體外循環下完成手術的患者(off-pump轉on-pump組，24例)與同期順利完成off-pump CABG患者(off-pump組，522例)進行對比分析，并行logistic多因素分析。結果在行off-pump CABG中，24例患者因心室顫動或血流動力學不穩定需緊急改變術式。Off-pump轉on-pump組患者中死亡4例，死亡率為16.7%(4/24)，明顯高于off-pump組［167% vs. 27%(14/522), P＜0001］。多因素logistic回歸分析結果提示急性心肌梗死(OR=3142, P=0004)、急診CABG(OR＝1571, P=0011)和右冠狀動脈狹窄≤90%(OR=1922, P=0024)為off-pump轉為on-pump的危險因素。結論 Off-pump緊急轉為on-pump時死亡率明顯增高，對同時合并有右冠狀動脈狹窄≤90%、急性心肌梗死和急診CABG等高危因素行off-pump CABG時，要做好體外循環的準備

引用本文： 郭惠明,吳若彬,鄭少憶等. 非體外循環緊急轉為體外循環冠狀動脈旁路移植術的分析. 中國胸心血管外科臨床雜志, 2007, 14(6): 418-. doi: 復制

1.	El-Hamamsy I, Cartier R, Demers P, et al. Long-term results after systemic off-pump coronary artery bypass graft surgery in 1000 consecutive patients. Circulation, 2006, 114(1 Suppl):I486-I491.
2.	Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
3.	Gal J, Grattan A, Kertai MD, et al. Coroanry revasculariation in transition from on-pump to off-pump: the effect of the off-pump coronary artery bypass on medium-term outcome. J Cardiovasc Surg (Torino), 2007, 48(1):67-72.
4.	Lahtinen J, Biancari F, Rimpilainen J, et al. Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE>/=6) . Thorac Cardiovasc Surg, 2007, 55(1):13-18.
5.	Rastan AJ, Eckenstein JI, Hentschel B, et al. Emergency coronary artery bypass graft surgery for acute coronary syndrome:　beating heart versus conventional cardioplegic cardiac arrest strategies. Circulation, 2006, 114(1 Suppl):I477-I485.
6.	Kerendi F, Puskas JD, Craver JM, et al. Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients. Ann Thorac Surg, 2005, 79(3):801-806.
7.	龔慶成，高泉鑫，楊王景, 等. 冠狀動脈旁路移植術非體外循環改為體外循環的原因. 中華胸心血管外科雜志, 2005, 21 (1) : 18-20.
8.	Reeves BC, Ascione R, Caputo M, et al. Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery. Eur J Cardiothoracic Surg, 2006, 29(6):941-947.
9.	Jin R, Hiratzka LF, Grunkemeier GL, et al. Aborted off-pump coronary artery bypass patients have much worse outcomes than on-pump or successful off-pump patients. Circulation, 2005, 112(9 Suppl):I332-I337.
10.	Edgerton JR, Dewey TM, Magee MJ, et al. Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg, 2003, 76(4):1138-1142.
11.	Song HK, Petersen RJ, Sharoni E, et al. Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve. Eur J Cardiothoracic Surg, 2003, 24(6):947-952.
12.	Babatasi G, Massetti M, Bruno PG, et al. Pre-operative balloon counterpulsation and off-pump coronary surgery for high-risk patients. Cardiovasc Surg, 2003, 11(2):145-148.
13.	Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American college of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004, 110(9):1168-1176.
14.	Légaré JF, Buth KJ, Hirsch GM. Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial. Eur J Cardiothorac Surg, 2005, 27(2):296-301.
15.	Gurbuz AT, Hecht ML, Arslan AH. Intraoperative transesophageal echocardiography modifies strategy in off-pump coronary artery bypass grafting. Ann Thorac Surg, 2007, 83(3):1035-1040.

1. 　El-Hamamsy I, Cartier R, Demers P, et al. Long-term results after systemic off-pump coronary artery bypass graft surgery in 1000 consecutive patients. Circulation, 2006, 114(1 Suppl):I486-I491.
2. 　Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
3. 　Gal J, Grattan A, Kertai MD, et al. Coroanry revasculariation in transition from on-pump to off-pump: the effect of the off-pump coronary artery bypass on medium-term outcome. J Cardiovasc Surg (Torino), 2007, 48(1):67-72.
4. 　Lahtinen J, Biancari F, Rimpilainen J, et al. Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE>/=6) . Thorac Cardiovasc Surg, 2007, 55(1):13-18.
5. 　Rastan AJ, Eckenstein JI, Hentschel B, et al. Emergency coronary artery bypass graft surgery for acute coronary syndrome:　beating heart versus conventional cardioplegic cardiac arrest strategies. Circulation, 2006, 114(1 Suppl):I477-I485.
6. 　Kerendi F, Puskas JD, Craver JM, et al. Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients. Ann Thorac Surg, 2005, 79(3):801-806.
7. 　龔慶成，高泉鑫，楊王景, 等. 冠狀動脈旁路移植術非體外循環改為體外循環的原因. 中華胸心血管外科雜志, 2005, 21 (1) : 18-20.
8. 　Reeves BC, Ascione R, Caputo M, et al. Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery. Eur J Cardiothoracic Surg, 2006, 29(6):941-947.
9. 　Jin R, Hiratzka LF, Grunkemeier GL, et al. Aborted off-pump coronary artery bypass patients have much worse outcomes than on-pump or successful off-pump patients. Circulation, 2005, 112(9 Suppl):I332-I337.
10. 　Edgerton JR, Dewey TM, Magee MJ, et al. Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg, 2003, 76(4):1138-1142.
11. 　Song HK, Petersen RJ, Sharoni E, et al. Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve. Eur J Cardiothoracic Surg, 2003, 24(6):947-952.
12. 　Babatasi G, Massetti M, Bruno PG, et al. Pre-operative balloon counterpulsation and off-pump coronary surgery for high-risk patients. Cardiovasc Surg, 2003, 11(2):145-148.
13. 　Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American college of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004, 110(9):1168-1176.
14. 　Légaré JF, Buth KJ, Hirsch GM. Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial. Eur J Cardiothorac Surg, 2005, 27(2):296-301.
15. 　Gurbuz AT, Hecht ML, Arslan AH. Intraoperative transesophageal echocardiography modifies strategy in off-pump coronary artery bypass grafting. Ann Thorac Surg, 2007, 83(3):1035-1040.

《中國胸心血管外科臨床雜志》

非體外循環緊急轉為體外循環冠狀動脈旁路移植術的分析

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《中國胸心血管外科臨床雜志》

非體外循環緊急轉為體外循環冠狀動脈旁路移植術的分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料