Goyal V, Pinto R J, Mukherjee K, Trivedi A, Sharma S, Bhattacharya S
Bombay Hospital and Medical Research Centre.
Indian Heart J. 1994 Nov-Dec;46(6):345-8.
Pulmonary function tests, arterial blood gas tensions and morbidity were compared in 50 patients undergoing coronary artery bypass graft surgery. Thirty patients had bilateral internal mammary grafts (Group 1), 5 patients had only saphenous vein grafts (Group 2) and 15 patients had a single arterial graft in addition to vein grafts (Group 3). Pleural effusion and wound infection were more common in patients with internal mammary artery grafts (p < 0.05). Patients in Group 2 required prolonged ventilation but this could be related to their underlying left ventricular dysfunction. Patients in all the three groups developed a severe restrictive ventilatory defect in the postoperative period and the degree of impairment was maximum in Group 1 patients (p < 0.01). These patients also had evidence of small airway obstruction. Thus an overall decrease in pulmonary function occurs in the postoperative period by 30 to 40% (p < 0.001). The derangement is greater in patients with arterial grafts, as a result of impaired blood supply, increase in pleural drains and additional surgical trauma secondary to mobilization of internal mammary arteries leading to delayed recovery. The awareness of these findings can be of great value in postoperative management of these patients. In addition, these observations should also be kept in mind while planning the choice of grafts in a patient undergoing coronary artery bypass graft surgery.
对50例接受冠状动脉搭桥手术的患者的肺功能测试、动脉血气张力和发病率进行了比较。30例患者采用双侧乳内动脉搭桥（第1组），5例患者仅采用大隐静脉搭桥（第2组），15例患者除静脉搭桥外还采用了单根动脉搭桥（第3组）。乳内动脉搭桥患者发生胸腔积液和伤口感染更为常见（p<0.05）。第2组患者需要延长通气时间，但这可能与其潜在的左心室功能障碍有关。所有三组患者在术后均出现严重的限制性通气功能障碍，第1组患者的损伤程度最大（p<0.01）。这些患者也有小气道阻塞的证据。因此，术后肺功能总体下降30%至40%（p<0.001）。由于血液供应受损、胸腔引流增加以及乳内动脉游离导致的额外手术创伤，动脉搭桥患者的紊乱更为严重，导致恢复延迟。了解这些发现对这些患者的术后管理具有重要价值。此外，在为接受冠状动脉搭桥手术的患者规划移植选择时，也应牢记这些观察结果。
