冠心病外科治疗英文

LIBEI

TheActualityandDevelopmentofCoronaryArterysurgeryLiBei

MDINTRODUCTION

CoronaryArteryDisease（CAD)isoneofthemostcommonandseriouseffectsofaging.Fattydepositsbuildupinbloodvesselwallsandnarrowthepassagewayforthemovementofblood.Theresultingcondition,calledatherosclerosisoftenleadstoeventualblockageofthecoronaryarteriesanda“heartattack”.

Since1900,CADhasbeentheNo.1killerintheUnitedStateseveryyearbut1918.Nearly2,600AmericansdieofCADeachday,anaverageof1deathevery33seconds.CADclaimsmoreliveseachyearthanthenext5leadingcausesofdeathcombined,whicharecancer,chroniclowerrespiratorydiseases,accidents,diabetesmellitus,influenzaandpneumonia.Almost150,000AmericanskilledbyCADeachyearareunderage65.Betyoudidn'tknow....INCHINAFrom1984~1998,themortalityratehasrisen.CADhasbeentheNo.3killerinChina.In2003,theprevalencerateofCADis4.6‰In2004,themortalityrateofCADis

46.27/100thousand.

Thisrateislowerthantheratein2000Newtrend:thepatientsarebecomemoreandmoreyounger,from1984~1998,themortalityrateofyoungmankindhaslargelyrisen,theextentreachto154%

dataiscomefrom《TheChineseCardiovascularDiseasereport2005》

ThesecelebritiesarealldiedofCAD.mostofthemarenotveryold.Theredeathevokedpeople’smoreattentiontoCADTHERISKHypertensionSmokingAbnormityofbloodlipidObesityoroverweightAbnormityofbloodsugarUnhealthylifestyleRiskFactorsUncontrollableSexHereditaryRaceAgeControllableHighbloodpressureHighbloodlipidSmokingPhysicalactivityObesityDiabetesStressandangerSignsandSymptomsNone:Thisisreferredtoassilentischemia.BloodtoyourheartmayberestrictedduetoCAD,butyoudon’tfeelanyeffects.Chestpain:Ifyourcoronaryarteriescan’tsupplyenoughbloodtomeettheoxygendemandsofyourheart,theresultmaybechestpaincalledanginapectorisShortnessofbreath:SomepeoplemaynotbeawaretheyhaveCADuntiltheydevelopsymptomsofcongestiveheartfailure-extremefatiguewithexertion,shortnessofbreathandswellingintheirfeetandankles.Heartattack:Resultswhenanarterytoyourheartmusclebecomescompletelyblockedandthepartyofyourheartmusclesfedbythatarterydies.Signs&SymptomsNoneChestPainShortnessOfBreathHeartAttackElectrocardiogram：wecanseetheECGsignsofmyocardialischemiaorinjury.ThisisvaluableforourdiagnosesCoronaryAngiography:thisisaveryusefultest,theresultwouldbethekingstandardforthediagnoses.ItalsocandefinitudethepathologicalarteriesBloodtests:usedtoevaluatekidneyandthyroidfunctionaswellastocheckcholesterollevelsandthepresenceofanemia.ChestX-ray:showsthesizeofyourheartandwhetherthereisfluidbuilduparoundtheheartandlungs.Echocardiogram:showsagraphicoutlineoftheheart’smovementTestsIncludeManypeopleareabletomanagecoronaryarterydiseasewithlifestylechangesandmedications.Otherpeoplewithseverecoronaryarterydiseasemayneedangioplasty(PCI)orsurgery(CABG).TreatmentTreatment(continued)1)Stenting

astentisintroducedintoabloodvesselonaballooncatheterandadvancedintotheblockedareaofthearterytheballoonistheninflatedandcausesthestenttoexpanduntilitfitstheinnerwallofthevessel,conformingtocontoursasneededtheballoonisthendeflatedanddrawnbackThestentstaysinplacepermanently,holdingthevesselopenandimprovingtheflowofblood.surgicalTreatment(continued)Bypasssurgery

healthybloodvesselisremovedfromleg,armorchestbloodvesselisusedtocreatenewbloodflowpathinyourheartthe“bypassgraft”enablesbloodtoreachyourheartbyflowingaround(bypassing)theblockedportionofthediseasedartery.Theincreasedbloodflowreducesanginapectorisandtheriskofheartattack.ConventionalCABG

（internationalrecognition）1onearterygraft(leftinternalmammaryarteryorleftsubclavianartery)2othersareveinGrafts(greatsaphenousvein)ThebestgraftforCABG—ITAITA（internalthoracicartery）isthebestgraftandincommonuse.Datashows,10yearsafteroperation,90%patients’ITAgraftsarestillpatencyITAcanrisethelivability,decreasetheheartattackandre-operationSTSDatabaseshows,inAmerican,88%patientsuseoneITA;InEngland,therateis90%;Inourhospital(XiangYahospital),therateisalso90%.

oneITAmustbeused!BITAORALLARTERIALGRAFTSomehospitalusingtwoITAs.DoseitbetterthansingleITA?(conclusion)

InAmerican,only3.5%patientsuseBITA.Wealsocanusemorethan2arterialgrafts.Theyare:ITA(oneortwo);RA(radialartery)andGE(rightgastroepiploicartery)

It'sbetterforyoungpatientstouseBITA!Thiswayisnotaroutine!SITAvsBITALivability7years10years15years20yearsSITA87785837BITA89816750AnnThoracSurg2004；78：2005-14Operativemethods

On-pumpCABG70-80%Off-pumpCABG20-30%Difference：whiletheheartisarrestedandusecardiopulmonarybypassornotwhenoperating

TheconclusionfromAHA(AmericanHeartAssociation)

Circulation，20051、on-pumpandoff-pump,whichisbetterisstillunconfirmed.Becausethemortalityrate,neuralfunctionandtheheartfunctionafteroperationisstillanalogical.2、Bothofthemhavegoodcurativeeffect,nomatteron-pumporoff-pumptheybothcanimprovetheprognosis.Butthepatients’prognosisismoredependonothernon-operativefactors.3、AlotofresearchindicatedthatthemortalityrateofCABGhasgreatdifference,from1%to6%.Thatmeanstheoperator’stechnique,theholisticmedicallevelandthepatients’ownconditionwillaffecttheprognosisalot.Off-pumpismorebetter?Off-pumpONPUMPTechnicaldifficultyissmallDoctorscangraspthisoperativewayfastthegraftscanbepatencyforlongtimeafteroperationEasytooperatingonthecircumflexartery

Maybealotofgrafts

MaybeaLittlebleedingRenalinsufficiencymaybeseldom

Short-termneu