Kameyama T, Okabayashi H, Shimada I, Ohno N, Noguchi H, Nishina T, Minatoya K, Soga K, Matsubayashi K, Kanai Y
Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan.
Kyobu Geka. 1995 Jun;48(6):452-6.
Since January 1992 till June 1994, we experienced 22 cases of coronary revascularization (CABG) under hypothermic ventricular fibrillation (Vf) in patients with unclampable ascending aorta (Group 2). We compared them with patients undergoing conventional CABG with cardioplegic cardiac arrest (Group 1). All these 362 cases were primary isolated CABG. Comparing preoperative patient profile, patients of Group 2 were older (Group 1: 64.3 +/- 8.5, Group 2: 68.2 +/- 6.7 year old, p < 0.05), had more unstable angina (Group 1: 20.3%, Group 2: 54.5%, p < 0.001), and had more severe NYHA classification (Group 1: 2.22 +/- 0.55, Group 2: 2.73 +/- 0.46, p < 0.05) than Group 1. There were no significant difference between both groups about other factors. Comparing post operative complication, low output syndrome (Group 1: 2.6%, Group 2: 18.2%, p < 0.005) perioperative myocardial infarction (PMI) (Group 1: 4.4%, Group 2: 36.4%, p < 0.0001) ventricular tachycardia (VT) (Group 1: 1.4%, Group 2: 18.2%, p < 0.0001), respiratory failure (Group 1: 3.8%, Group 2: 18.2%, p < 0.005), and post operative hospital death (Group 1: 2.9%, Group 2: 18.2%, p < 0.0005) occurred more frequent in Group 2 than Group 1. Other complication (renal failure, wound infection, cerebrovascular accident, rethoracotomy for bleeding) equally occurred in both groups. Long Vf time (mean 92.8 minutes) and low perfusion pressure during Vf (mean 60.0 mmHg) were suspected to be major cause of high incidence of PMI and VT in Group 2. But there were no correlation between Vf time, perfusion pressure and occurrence of PMI and/or VT.(ABSTRACT TRUNCATED AT 250 WORDS)
自1992年1月至1994年6月，我们在升主动脉无法夹闭的患者中，经历了22例在低温心室颤动（室颤）下进行冠状动脉血运重建（冠状动脉旁路移植术，CABG）的病例（第2组）。我们将他们与接受传统心脏停搏下CABG的患者进行比较（第1组）。所有这362例病例均为初次单纯CABG。比较术前患者资料，第2组患者年龄更大（第1组：64.3±8.5岁，第2组：68.2±6.7岁，p<0.05），不稳定型心绞痛更多（第1组：20.3%，第2组：54.5%，p<0.001），纽约心脏协会（NYHA）分级更严重（第1组：2.22±0.55，第2组：2.73±0.46，p<0.05）。两组在其他因素方面无显著差异。比较术后并发症，第2组低心排血量综合征（第1组：2.6%，第2组：18.2%，p<0.005）、围手术期心肌梗死（PMI）（第1组：4.4%，第2组：36.4%，p<0.0001）、室性心动过速（VT）（第1组：1.4%，第2组：18.2%，p<0.0001）、呼吸衰竭（第1组：3.8%，第2组：18.2%，p<0.005）及术后院内死亡（第1组：2.9%，第2组：18.2%，p<0.0005）的发生率均高于第1组。其他并发症（肾衰竭、伤口感染、脑血管意外、因出血再次开胸）在两组中发生率相同。较长的室颤时间（平均92.8分钟）及室颤期间较低的灌注压（平均60.0 mmHg）被怀疑是第2组PMI和VT高发生率的主要原因。但室颤时间、灌注压与PMI和/或VT的发生之间无相关性。（摘要截短至250字）
