Brummett C, Reves J G, Lell W A, Smith L R
Can Anaesth Soc J. 1984 Mar;31(2):213-20. doi: 10.1007/BF03015264.
Over the past six years there has been a 15-fold increase in the number of patients requiring reoperation coronary artery bypass grafting (RCABG) surgery at the University of Alabama in Birmingham. To determine the perioperative risk, a retrospective chart survey of one calendar year's (1981) experience was made comparing the 58 RCABG patients with 59 cohorts undergoing primary operation. All patients were anaesthetized with diazepam, fentanyl and halothane or enflurane anaesthesia. Preoperative evaluation revealed by history that the incidence of unstable angina and digoxin use were greater (p = 0.05) in the RCABG patients. Cardiac catheterization revealed a higher incidence (26 vs 89 percent) of left main coronary disease in controls and similar indices of left ventricular function (wall abnormalities, ejection fraction and LVEDP). Operating and bypass times were longer (p less than 0.01) for RCABG patients and there was a trend for greater (p = 0.08) use of dopamine in the RCABG patients. CK-MB release was significantly (p less than 0.05) greater in RCABG patients. Serious postoperative complications (CK-MB greater than or equal to 15 IU/L, low cardiac output, and death) were significantly (p = 0.02) greater in the RCABG group. It is concluded that RCABG patients represent a greater risk of complications and that new strategies for improving myocardial protection need to be developed to reduce the risk.
在过去六年中，阿拉巴马大学伯明翰分校需要再次进行冠状动脉搭桥手术（RCABG）的患者数量增长了15倍。为了确定围手术期风险，对1981年一整年的经验进行了回顾性图表调查，将58例接受再次冠状动脉搭桥手术的患者与59例接受初次手术的患者队列进行比较。所有患者均采用地西泮、芬太尼和氟烷或恩氟烷麻醉。术前病史评估显示，再次冠状动脉搭桥手术患者中不稳定型心绞痛的发生率和地高辛的使用情况更高（p = 0.05）。心脏导管检查显示，对照组左主干冠状动脉疾病的发生率更高（26% 对89%），而左心室功能指标（室壁异常、射血分数和左心室舒张末期压力）相似。再次冠状动脉搭桥手术患者的手术时间和搭桥时间更长（p < 0.01），并且再次冠状动脉搭桥手术患者使用多巴胺的趋势更大（p = 0.08）。再次冠状动脉搭桥手术患者的肌酸激酶同工酶（CK-MB）释放显著更高（p < 0.05）。再次冠状动脉搭桥手术组严重术后并发症（CK-MB大于或等于15 IU/L、低心输出量和死亡）显著更多（p = 0.02）。结论是，再次冠状动脉搭桥手术患者并发症风险更大，需要制定新的策略来改善心肌保护以降低风险。
