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目的总结 2 1例重症冠心病非体外循环冠状动脉搭桥手术的临床体会。方法先行乳内动脉与前降支的吻合 ,或在主动脉内球囊反搏支持下完成手术。结果平均手术时间 2 16(196～ 2 86)分钟。 3例搭桥 3根 ,15例搭桥 4根 ,3例搭桥 5根 (4根 /人 )。平均术后呼吸机辅助时间 6(3～ 8)小时。术后应用多巴胺和多巴酚丁胺进行循环功能支持者 14例 ,应用主动脉内球囊反搏 2例 ,均于术后 48小时内撤除。术后早期发生房颤、房扑伴阵发性室上速者 12例 ,频发室性早搏者 3例 ,心包填塞二次开胸止血者 2例。结论重症冠心病非体外循环冠状动脉搭桥手术 ,应充分进行术前准备 ,制订合理的麻醉和手术方案 ,加强术中密切配合 ,重视全面的术后处理
Objective To summarize the clinical experience of 21 cases of coronary heart disease undergoing coronary artery bypass grafting without cardiopulmonary bypass. Methods First anastomosis of the internal mammary artery and anterior descending artery, or surgery in the aortic balloon counterpulsation. Results The average operation time was 2 16 (196 ~ 2 86) minutes. 3 cases of bypass 3, 15 cases of bypass 4, 3 cases of bypass 5 (4 / person). The average postoperative ventilator assistance time 6 (3 ~ 8) hours. Postoperative application of dopamine and dobutamine for circulation supporters in 14 cases, the application of intra-aortic balloon pump in 2 cases, were removed within 48 hours after surgery. Postoperative early atrial fibrillation, atrial flutter with paroxysmal supraventricular tachycardia in 12 cases, frequent ventricular premature beats in 3 cases, pericardial stuffing secondary thoracotomy in 2 cases. Conclusion Severe coronary heart disease non-cardiopulmonary bypass coronary artery bypass grafting surgery should be fully preoperative preparation of a reasonable anesthesia and surgical programs to strengthen the close cooperation in operation, pay attention to a comprehensive postoperative treatment