本页包含以下部分:
什么时候冠状动脉旁路移植是可取的?
冠状动脉旁路移植术是如何完成的?
这种手术的风险和好处是什么?
典型的复苏包括什么?
什么时候冠状动脉旁路移植是可取的?
冠状动脉旁路移植术(也称为CABG), 发音像“卷心菜”," or as bypass surgery) involves creating a new pathway for blood to flow around a blockage in one or more of the arteries that supply the heart itself with blood; these are known as your 冠状动脉. 在美国，冠状动脉搭桥手术是最常用的开胸手术.S. Bypass operations have been more extensively performed and more extensively studied than any other cardiac operation in the country, 自从20世纪60年代手术开始以来.
这是一种非常有效的治疗方法 冠状动脉疾病 (CAD) or coronary heart disease—a blockage in the 冠状动脉 that is usually due to a problem called atherosclerosis; atherosclerosis is caused by the progressive buildup of plaque, 或者胆固醇沉积, 动脉壁上的炎症细胞和其他物质. In some situations—such as when a major heart attack is determined to have been caused by CAD or when CAD is causing severe symptoms involving multiple 冠状动脉—冠状动脉疾病 may be life-threatening, 可能需要紧急搭桥手术.
在病情严重的情况下，也可以考虑冠状动脉搭桥手术 心绞痛 or 充血性心力衰竭. 这些情况不太可能代表紧急情况. Your surgeon will likely be able to take the time to evaluate the specifics of your situation and help you weigh the risks of bypass surgery against the risks of continuing to manage your 心绞痛 or 充血性心力衰竭 with medication and other nonsurgical treatments.
你是否需要在紧急情况下进行冠状动脉搭桥手术, 或者你和你的外科医生决定是时候做搭桥手术了, keep in mind that our cardiac surgeons have considerable expertise in performing this very common procedure.
冠状动脉旁路移植术是如何完成的?
The basic premise of CABG surgery is that healthy blood vessels from elsewhere in your body—most often, veins from your legs and/or mammary arteries from your chest—are used to replace your blocked 冠状动脉. The procedure can be performed on just one coronary artery or on several at the same time; you may hear bypass surgery called a "two-way bypass" or "double bypass,例如:, or a "four-way bypass" or "quadruple bypass"—this is a reference to the number of arteries involved.
手术名称中的“旁路”一词意味着你的血液循环将会分流, 或者四处游荡, 冠状动脉阻塞的部分. “graft”是一个用来描述活体组织移植的术语(在这种情况下), 一些你自己的血管)从一个地方到另一个地方. 你可能还会听到其他一些关于搭桥手术的术语. An "anastomosis" is a surgical connection between one tubular organ and another—in the case of a CABG, 在你的冠状动脉和身体其他部位的静脉或动脉之间. And "revascularization" means re-establishing an adequate flow of blood to a part of the body that has suffered from a poor blood supply (a condition known as ischemia, 这个词来自拉丁语，意思是“止血”)。. 换句话说, CAD导致心脏缺血, 或者心脏供血不足, 而冠状动脉搭桥导致血运重建术, 或者恢复良好的血液供应, 多亏了吻合术.
The vessels used in a CABG procedure can be either veins or arteries and can come from several locations, 包括你的腿, 武器, 和/或胸部. 在所有情况下, 你的循环系统能够补偿血管的移除和重新利用. 你的外科医生决定的来源将取决于许多因素, 包括必须绕过多少冠状动脉，以及你的整体健康状况. 最常, bypass grafts are performed using veins from your legs and/or one or both of your mammary arteries—the arteries that supply your chest with blood.
研究表明，乳腺旁路移植术的最佳来源是乳腺动脉, because they are less likely to suffer reblockage than vein grafts and thus result in better long-term survival. We have one of the highest rates in northern New England for utilization of bilateral mammary arteries ("bilateral" means "from both sides").
旁路手术通常包括心内直视手术和内窥镜手术. 在手术过程中，通常需要停止心脏跳动. A device known as a heart-lung bypass machine will be used to maintain your circulation during this time.
The endoscopic portion of the operation involves making a couple of tiny incisions (often just 1 to 2 inches) in your leg. 然后是内窥镜, 一种顶端装有照相机的软管, 和长, 薄薄的手术器械通过切口插入, 允许外科医生从你的腿上“采集”静脉.
手术的开胸部分包括通过分割胸骨进入胸腔, 或胸骨, 分离胸壁的肌肉, 通过一个大切口(通常是5到7英寸)进入心脏, 有时会在你的胸部深达10英寸. 手术本身包括缝合, 或缝纫, the harvested leg veins and/or rerouted mammary arteries into place so the flow of blood from your aorta to your heart itself goes through these newly placed vessels rather than through 冠状动脉阻塞的部分. 在手术过程中有必要让你的心脏停止跳动, so the operation can be performed on a motionless and bloodless field; while your heart is stopped, a device known as a heart-lung bypass machine will take over your heart's function and maintain your circulation.
这种手术的风险和好处是什么?
It is important to keep in mind that every medical choice involves a trade-off between risks and benefits—whether it is to undergo surgery, 服药, 或者甚至只是仔细监控一种情况(一种被称为“观察等待”的选择)。.
如果是CABG, 决定手术是否明智有时是一种紧急情况, 生死攸关的问题. 但有时, it involves balancing the risks involved in any heart surgery against the increasing likelihood that your symptoms of CAD, 心绞痛或充血性心力衰竭会加重. 严重冠心病患者, 例如, have a 35% to 50% risk of dying within five years of their diagnosis if they don't have bypass surgery.
手术的风险要低得多. 不同病人的风险会有所不同, 取决于年龄和整体健康状况等因素, 但是平均死亡率, 或者死亡的风险, 在搭桥手术中是1%到2%. Bypass surgery is also associated with a risk of between less than 1% and 2% of a blood clot that causes a serious heart attack or stroke. 而且任何外科手术都有很小的并发症风险，比如感染.
当必须在紧急情况下进行搭桥手术时，风险通常更高. 但在非紧急情况下, patients who smoke can reduce their risk of complications if they stop smoking at least 2 to 4 weeks before their surgery (it is best not to quit immediately before having heart surgery, 然而, 因为当人们戒烟时，他们经常会有短期的支气管漏, 或者是呼吸道分泌物过多, which makes them cough a lot—and coughing a lot when you have just had heart surgery is not a good idea).
成功修复的好处是相当可观的. 绝大多数接受搭桥手术的病人, 一旦他们恢复, feel better than they did before the operation and are able to resume any activities they wish to engage in. Bypass surgery typically reduces patients' symptoms of 心绞痛 and risk of having a heart attack and increases their survival.
典型的复苏包括什么?
一个典型的冠脉搭桥手术需要4到6个小时, in some cases up to 8 hours; patients are then maintained under general anesthesia for an additional 4 to 6 hours. 如果他们的心脏运转良好，没有过多的出血, 他们可以从麻醉中恢复过来，并拔掉呼吸管. Most patients stay in the ICU until midday of the day after their procedure; if they continue to do well, the drainage tubes in their chest can then be removed and they can be moved to a regular hospital bed later that day.
典型的住院时间为4到7天. 在这一点上, 绝大多数病人都能回家, 在探访护士服务的支持下, though about 15% to 20% may need to spend some time in a rehab facility for more extensive rehabilitation. 出院后, patients are advised not to drive for about three weeks and not to lift anything heavier than 5 pounds for about 6 weeks. 超过这个点，他们可以恢复他们想要的任何活动.
病人往往会惊讶于控制疼痛是多么容易. 手术后的第二天, 大多数病人不用静脉注射止痛药物就会感到舒服, 只服用口服止痛药, 绝大多数人出院后只服用泰诺或布林.
审查页面:2018年6月26日
编辑:Jock McCullough, MD