Koike R, Suma H, Oku T, Satoh H, Sawada Y, Takeuchi A
Department of Thoracic Surgery, Osaka Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Nov;38(11):2314-9.
Three patients with systemic disease requiring steroids, in whom coronary artery bypass grafting (CABG) was performed, are reported in this paper, Anesthetic problems and operative managements for such patients are also discussed. Patient 1, 57-year-old male with thrombocytosis underwent emergency double CABG using saphenous vein and the Bioflow graft. He discharged with freedom from angina. Patient 2, 59-year-old male with polymyositis who had been receiving steroid for 10 years underwent quadruple CABG using bilateral internal thoracic arteries with sequential technique and the Bioflow graft, but he died of multiple organ failure on 16 days after operation. Postmortem examination revealed that coronary artery sclerosis progressed more severely than we had expected from angiography. All the graft anastomosed were completely patent. Histological examination showed that the saphenous vein was fragile. The pathological changes might be due to steroid administration. On the other hand, arterial grafts were completely normal. Patient 3, 37-year-old male with idiopathic thrombocytopenic purpura who had been on steroids underwent combined triple CABG using internal thoracic artery, gastroepiploic artery and the Bioflow graft and splenectomy. He discharged with freedom from angina and tendency to bleed. Postoperative angiography showed both arterial grafts were well patent and left ventricular wall motion vastly improved. From our experience, a careful consideration of the bypass conduit is a major problem in such patients requiring steroids.
本文报告了3例患有全身性疾病且需要使用类固醇治疗的患者，他们接受了冠状动脉旁路移植术（CABG），并讨论了此类患者的麻醉问题和手术管理。病例1，一名57岁的男性血小板增多症患者，接受了使用大隐静脉和Bioflow移植物的急诊双支冠状动脉旁路移植术。他出院时无心绞痛发作。病例2，一名59岁的男性多肌炎患者，已接受类固醇治疗10年，接受了使用双侧胸廓内动脉采用序贯技术和Bioflow移植物的四支冠状动脉旁路移植术，但术后16天死于多器官功能衰竭。尸检显示冠状动脉硬化进展比血管造影预期的更严重。所有移植吻合口均完全通畅。组织学检查显示大隐静脉脆弱。病理改变可能归因于类固醇的使用。另一方面，动脉移植物完全正常。病例3，一名37岁的男性特发性血小板减少性紫癜患者，一直在使用类固醇治疗，接受了使用胸廓内动脉、胃网膜动脉和Bioflow移植物的三联冠状动脉旁路移植术及脾切除术。他出院时无心绞痛发作且出血倾向改善。术后血管造影显示两支动脉移植物均通畅良好，左心室壁运动明显改善。根据我们的经验，对于此类需要使用类固醇的患者，仔细考虑旁路血管是一个主要问题。
