杂交技术对老年多支复杂冠心病患者早期疗效及预后的影响

发布时间：2018-03-21 20:27

本文选题：杂交技术　切入点：微创冠状动脉搭桥　出处：《中国老年学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨分期非体外循环微创冠状动脉搭桥(MIDCAB)联合经皮冠状动脉介入(PCI)杂交技术治疗老年多支复杂冠心病患者的早期疗效及预后。方法选取31例年龄60~83岁多支复杂冠心病患者,用血管内超声(IVUS)和血流储备分数(FFR)对病变进行评估,采取分期非体外循环对前降支(LAD)和左内乳动脉(LIMA)行微创冠状动脉搭桥(MIDCAB),对非LAD血管右冠状动脉(RCA)和回旋支(LCX)植入支架。观察早期院内指标及随访1~3年主要心血管不良事件情况。结果复杂病变(B2+C型)占83.2%,人均植入支架1.6个,人均再血管化2.6支,合理使用抗凝抗血小板药物,胸腔引流量(312±195)ml,输血占29%,术后脱机时间(8.0±3.2)h,ICU时间(24±8)h,无PCI及MIDCAB死亡病例,无二次开胸及脑卒中。随访1~3年再血管化PCI 2例,均非LAD病变,再发心绞痛4例,无心源性死亡、急性心肌梗死及急性心衰病例。结论合理选择病例,科学评估病变,分期杂交技术可用于多支复杂病变的老年冠心病患者,早期及预后安全有效。
[Abstract]:Objective to investigate the early efficacy and prognosis of minimally invasive coronary artery bypass graft (MIDCAB) combined with percutaneous coronary intervention (PCI) hybridization in the treatment of elderly patients with complex coronary artery disease. Patients with complex coronary artery disease, The lesions were evaluated by intravascular ultrasound (IVUS) and flow reserve fraction (FFR). The anterior descending artery (lad) and left internal mammary artery (LIMA) were treated by staging off-pump bypass (LAD) and left internal mammary artery (LIMA). Stent implantation was performed on the right coronary artery (RCA) and circumflex branch (LCX) of non LAD vessels. The early hospital parameters and the follow-up of major cardiovascular diseases were observed and followed up for 1 ~ 3 years. Results the incidence of complex lesions was 83.2%, and the average number of stents implanted was 1.6. There were 2.6 revascularization per capita, rational use of anticoagulant and antiplatelet drugs, pleural drainage volume (312 卤195ml), blood transfusion (29.9%), postoperative weaning time (8.0 卤3.2hICU), 24 卤8h. no PCI and MIDCAB death, no rethoracotomy and stroke. 2 cases were followed up for 1 ~ 3 years and then re-vascularized PCI. There were no cardiac death, acute myocardial infarction and acute heart failure in 4 patients with non-#en0# disease, 4 patients with recurrent angina pectoris. Conclusion reasonable selection of cases, scientific evaluation of pathological changes and staging hybridization technique can be used in elderly patients with multiple complex coronary artery disease. The early stage and prognosis are safe and effective.
【作者单位】：河南省胸科医院心内科;河南省胸科医院心外科;
【分类号】：R541.4

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