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Heart bypass Surgery

Coronary artery bypass grafting

Heart bypass surgery is also called coronary artery bypass Transplantation , when one or more coronary arteries atherosclerosis In case of insufficient blood supply due to stenosis and obstruction Coronary stenosis A surgical procedure in which a passage is established between the proximal and distal ends of the coronary artery to allow blood to bypass the stenosis and reach the distal end. Take more blood vessels of the patient, such as Great saphenous vein 、 Internal mammary artery 、 Right gastroepiploic artery 、 radial artery 、 Inferior epigastric artery The distal part of the narrowed coronary artery and aorta Connect to let the blood bypass the narrow part to reach ischemia Part of. Cardiac bypass surgery is a recognized treatment coronary heart disease The most effective method can improve the blood supply of myocardium to achieve relief angina pectoris Symptoms, improving cardiac function, improving Quality of life 、 Extended life The purpose of.

Chinese name

Anesthesia mode

general anesthesia

indication

Those whose symptoms of myocardial ischemia cannot be controlled by medical treatment

contraindication

Severe heart, brain, lung and kidney dysfunction

atlas

Science popularization in China

Committed to authoritative science communication

The certification expert of this term is

Wang Chun | Deputy chief physician

Cardiovascular Surgery Department of the Military Rehabilitation Center to examine

catalog

six Postoperative care
seven Postoperative diet

essential information

Chinese name: Heart bypass Surgery
Anesthesia mode: general anesthesia

indication: Those whose symptoms of myocardial ischemia cannot be controlled by medical treatment
contraindication: Severe heart, brain, lung and kidney dysfunction

Anesthesia mode and preoperative preparation

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one anaesthesia Mode（ general anesthesia 。）

two Preoperative preparation

(1) Inquire the medical history in detail before operation, especially whether there is complication , including hypertension 、 miocardial infarction 、 diabetes 、 cerebral apoplexy , Liver Renal insufficiency , Heart History of operation Etc.

(2) Carry out a thorough physical examination, and pay attention to whether there is carotid artery Noise Cardiac murmur 、 Lung rale and Varicose veins of lower limbs , and whether there are signs of peripheral vascular disease.

(3) Preoperative Coronary angiography To determine the location and extent of coronary artery stenosis.

(4) Routine Echocardiography 、 electrocardiogram 、 Chest X-ray , liver and kidney Functional inspection 、 Coagulation function , blood sugar, etc.

(5) Do Internal mammary artery or radial artery Ultrasonic examination To understand its status as a bridge vessel for selection.

(6) Preoperative routine anti platelet 、 Nitrates and Beta receptor Blockers, etc.

(7) Compliance Doctor's order Prepare the skin, and inform the patient that he/she is forbidden to eat at 20 o'clock and water at 24 o'clock the night before the operation.

indication

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Myocardial ischemia Those whose symptoms cannot be controlled by medical treatment. include:

1. Left main artery disease: surgical operation It is the first choice for treatment of left main trunk disease.

2. Three or more vessels Diffuse pathological changes.

3. Companion Cardiac insufficiency Person: requiring completeness Revascularization To promote ischemia Myocardial recovery.

4. Patients with diabetes: more than two vascular diseases, especially with Anterior descending branch Proximal stenosis.

5. Heart emergency: partial interventional therapy Failure or acute complication Such as severe coronary artery injury Cardiac tamponade 、 Perforation of ventricular septum Etc. or acute myocardial infarction companion Cardiogenic shock 。

6. Anti platelet Drug allergy The.

Contraindication

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one coronary artery The distal vessel diameter of the lesion is<1mm.

2. Severe heart, brain, lung, liver Renal insufficiency , those who cannot tolerate surgical trauma.

Surgical methods

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one Great saphenous vein bypass

The operation was carried out under systemic circulation, and two groups were divided into two groups for simultaneous thoracotomy and great saphenous vein resection. The operation should be light, do not damage the vein, and ligate the small branches; During ligation, the venous lumen should be prevented from narrowing due to traction. The proximal and distal ends of the removed great saphenous vein should be marked. Because the valve of the great saphenous vein is closed, it can block blood flow Ascending aorta The proximal end was anastomosed with the coronary artery.

It is easy to use great saphenous vein bypass Vascular intima Hyperplasia, serious cases can cause bridge blockage within 3 months, and most of the great saphenous vein bridges will be blocked to varying degrees 5 years after surgery.

2. Internal thoracic artery bypass

The long-term patency rate of internal thoracic artery bypass is good, and the 10-year patency rate is>90%. Internal thoracic artery It can supply blood according to the heart muscle Physiological needs And adjust blood flow The chance of atherosclerosis is very small, but the length of the internal thoracic artery is limited. Left internal thoracic artery It is mainly used as left anterior descending artery bypass, and the right internal thoracic artery can be connected with Right coronary artery Or the posterior descending branch is anastomosed, and other blood vessels need to be connected with the great saphenous Venous vessel Bridge merge application.

3. Radial artery bypass

In recent years, due to the improvement and use of surgical techniques Calcium channel blockers prevent Vasospasm As well as postoperative anticoagulant treatment, the patency rate of the radial artery was greatly improved, reaching 90% in 5 years.

matters needing attention

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1. Assist the patient in taking Supine position , lift the chest.

2. Take Great saphenous vein and Thoracotomy The equipment of the device should be separated to avoid pollution.

3. Prepare in advance Defibrillator , ready for cardiopulmonary bypass at any time.

Postoperative care

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1. Monitor heart rate closely after operation Rhythm , blood pressure and body temperature. Nitrates should be properly used to effectively dilate the coronary artery of patients and improve Blood supply 。

2. Record and control liquid input and output to ensure water electrolyte and acid-base balance 。 Appropriate use of vasodilators, measurement Central venous pressure , guidance Volume of fluid replacement And speed.

3. The patient should be removed as soon as possible Tracheal intubation , guide the patient how to cough Expectoration. If the patient cannot Expectoration , should give assistant expectoration, strengthen turning over and knocking on the back, and give mechanical sputum suction if necessary.

4. Left Cardiac insufficiency Patients can use aorta Balloon counterpulsation machine assistance.

5. The patient should properly lift and extend the limbs after waking up to facilitate blood circulation and observe Dorsalis pedis artery Pulsation and limbs End Cycle with Elastic bandage Tighten the operative limb to prevent Thrombosis 。 Instruct patients to move in bed early.

6. Postoperative needs Anticoagulant therapy 6 months.

Postoperative diet

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After the operation, it is necessary to take adequate amount of fruits and vegetables every day and eat more protein content High food (such as fish, eggs, etc.) and Unsaturated fatty acid Eat less food Saturated fatty acid High content food. Quit smoking and limit alcohol consumption.

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