張建卿① 程兆雲② 肖明第① 顧以茼② 賈寶成① 陶運明① 萬亞紅① 陳明寶① 鐘森① 王廣利① Maiza③
①上海遠大心胸醫院心外科（上海，200235，中國）
②河南省人民醫院心外科（鄭州，450003，中國） 
③法國CAEN大學醫學院心外科
The application of “skeleton” dual internal thoraric artery in elder patients with coronary artery bypass surgery
ZHANG Jianqing①,CHENG Zhaoyun②,XIAO Mingdi①,GU Yitong②,JIA Baocheng①,TAO Yunming①,WAN Yahong①,CHEN Mingbao①,ZHONG Sen①,WANG Guangli①,Maiza③
①Shanghai Yodak Cardiovascular Hospital（Shanghai，200235，China）
②Dept.cardiac surgery, Henan Province People's Hospital （Henan，450003，China）
③Dept.cardiac surgery,CAEN University,France
摘要  目的  探討“骨胳化”雙胸廓內動脉在高齡患者冠脉搭橋術中的應用。方法  202例年齡大于65歲的不停跳冠狀動脉搭橋病人采用雙側裸化的乳內動脉，急診手術8例，部分病人合幷有糖尿病，高血壓及慢性阻塞性肺疾病。橋血管采取裸化的、去組織的乳內動脉，儘量保留了胸骨血供的側支循環。結果  202例患者平均搭橋3.2支。手術死亡率(術後30天內)3%。其中年齡大于80歲死亡率(6.8%)，小于80歲以下者(1.4%)，術後圍手術期心梗5例(2.5%)，有胸骨感染4例(2%)。還有4例(2%)因術後滲血二次開胸止血。結論  高齡患者冠脉搭橋中采用裸化的乳內動脉作爲旁路材料其手術死亡率低，術後生存率高，心功能顯著改善，而胸骨感染的發生率低。但在合幷有慢性阻塞性肺疾病、糖尿病及急診手術中應慎重考慮。
Abstract  Objective  To explore the application of "skeleton" dual internal thoracic artery in elder patients with coronary artery bypass surgery. Methods  202 cases older than 65-year-old beating coronary artery bypass using the naked mammary artery were enrolled, eight cases of emergency surgery, some patients with diabetes, hypertension and chronic obstructive pulmonary disease. Grafts take of naked, to organize the internal mammary artery and the sternum to preserve the blood supply of collateral circulation. Results  There were an average of 3.2 bypass each patient.Surgical mortality(≤30 days after operation) was 3%.The mortality in those more than 80 years olds was 6.8%,below 80 was 1.4%.There were five cases(2.5%) with perioperation myocardial infarction,four cases(2%) with sternal infection,four cases(2%) with postoperative blecding secondary thoracotomy to stop blecding.Conclusion  There were a low mortality,high survival rate,cardiac function improved significantly and low incideuce of sternal infection in elder patients with coronary artery bypass graft used in the nude mterual mammary artery bypass surgery.However, the merger with chronic obstructive pulmonary disease, diabetes and emergency surgery should be carefully considered.
1．資料與方法
1.1  資料
從1999年6月到2007年6月，202例年齡大于65歲的冠狀動脉搭橋病人采用雙側裸化的乳內動脉，占同期所有搭橋病人的45%，其中年齡大于80歲者30例，左主幹狹窄者20例，部分病人合幷有糖尿病，高血壓及慢性阻塞性肺疾病。急診手術8例，見表1。