小切口微创冠状动脉搭桥术的临床研究

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1、授予单位代码10089学号或申请号20122471HebeiMedicalUniversity硕士学位论文科学学位小切口微创冠状动脉搭桥术的临床研究研究生：刘建成导师：王东教授专业：外科学二级学院：唐山工人医院2015年3月河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师（或指导小组）的指导下，由本人独立完成。本学位论文研究所获得的研究成果，其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文，第一署名为单位河北医科大学，试验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。否则，承担相应法律贝任

2、。研究生签名；导师签章:月河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加以标注和致谢等内容外，文中不包含其他人已经发表或撰写的研究成果，指导教师对此进行了审定。本论文由本人独立撰写，文责自负。研究生签名导师签章：爽rbli-年目录中文摘要·······························································1英文摘要·······························································3英文缩写··········

3、·····················································6研究论文小切口微创冠状动脉搭桥术的临床研究前言·······························································7材料与方法·······················································8结果·······························································10附图······················

4、·········································13附表······························································19讨论·······························································23结论·······························································29参考文献··············································

5、············29综述微创冠状动脉搭桥术的应用进展······························31致谢·····································································39个人简历································································40中文摘要小切口微创冠状动脉搭桥术的临床研究摘要目的：近10余年来，各种微创冠状动脉旁路移植手术己在国内外多家心脏中心广泛开展，报道均取得良好效果。本文比较了胸骨下段小切口与常规

6、胸骨正中切口治疗冠状动脉单支以及多支病变的手术效果，并总结相关的经验体会。方法：2014年1月—2015年1月，按照标准(符合冠状动脉旁路移植术的冠心病患者，微创组与对照组间术前一般情况无明显差异，具有可比性。心功能为NYHAI-III级，排除合并瓣膜病患者。既往无心脏或胸部手术史)入选的患者共41人，按随机和征求患者其家属意见相结合的方法分成两组：微创组（单纯前降支病变14例，二支病变4例，三支病变2例）共20人，经胸骨下段小切口行非体外循环冠状动脉搭桥术；对照组（单纯前降支病变13例，二支病变5例，三支病变3例）共21人，经胸骨正中切口行非体外循环冠状动脉搭桥术。分析两组患者

7、的临床指标：术前患者一般情况（年龄、体重、NYHA、术前LvEF、心肌酶(CK、CK-MB、LDH)、肌钙蛋白、NT-proBNP、冠状动脉造影情况、合并其他脏器严重疾病等）；术中（切口长度、乳内动脉获取时间、桥血管吻合时间、总手术时间、术中出血量及输血量、是否发生恶性事件转换手术方式等）；术后（呼吸机辅助呼吸时间、ICU监护时间、住院天数、术后引流量、输血量，手术效果指标：术后心、肺功能恢复情况（术后LvEF、心肌酶（CK、CK-MB、LDH）、肌钙蛋白、NT-ProBNP、呼