摘要：目的 对急诊冠状动脉搭桥移植(ECABG)体外循环(CPB)过程的特殊性及处理要点加以总结，以减少CPB并发症，提高ECABG成功率。方法 对1999年1月~2002年3月38例急诊ECABG CPB过程，心肌保护措施，处理要点及行非体外冠状动脉ECABG时CPB准备方法进行分析总结。结果 30例行CPB下急诊ECABG，平均CPB时间(119.0±32.5)min,平均阻断时间(66.2±24.3)min,平均辅助时间(45.8±13.6)min；2例行CPB辅助下不停跳搭桥，26例开放升主动脉后自动复跳，自动复跳率92.8%。8例行不停跳搭桥。1例于术后10d死于呼吸衰竭，1例于术后第九日在病房猝死，考虑急性肺栓塞。1例PTCA时致前降支穿孔、心包填塞的81岁女性患者术后第四天死于循环衰竭。其余随访2~25m无死亡及其它系统严重并发症，无明显心绞痛及心肌缺血表现。结论 合理的CPB管理是提高移植术(ECABG)成功率的重要条件之一。

    关键词：冠状动脉搭桥术；急诊；体外循环

    The Analysis of Cardiopulmonary Bypass Process in Emergency Coronary Artery Bypass Grafting

    I Yan-jun ，ZHANG Yun ，HAN Wei，SU Pi-xiong，LIU Yan，ZHANG Xi-tao，YAN Jun,GU Song,SUN Lin-po,LIU Yong-chun

    (Department of Cardiac Surgery,Chaoyang Hospital,Beijing 100020,China)

    Abstract: OBJECTIVE To sum up the experience of Cardiopulmonary Bypass(CPB) Process in emergency coronary artery bypass grafting(ECABG),for reducing the complications of CPB and increasing the rate of success of ECABG..METHODS Thirty-eight patients underwent ECABG from Jan,1999 to Mar,2002. 30 cases with CPB including 2 cases on-pump beating heart. The process of CPB, the measures for myocardial protection and the stand by for off-pump ECABG are analyged.RESULTS 30 cases are on-pump ECABG. 8 are off-pump. The average time of CPB 119.0±32.5min, the ischemia time 66.2±24.3,supplementary time 45.8±13.6,the rate of heart rebeating 92.8%, 8 cases undertook off-pump ECABG. 3 cases died, one died of respiratory dysfunction, one pulmonary thromboemlism and one heart failure, there was no serious complications, angina and myocardial ischemia in 35 suruioals.CONCLUSION The adequate managements of CPB is the key factor for increasing the rate of success of ECABG. ......