冠心病外科治疗英文

冠心病外科治疗英文INTRODUCTION

CoronaryArteryDisease〔CAD)isoneofthemostcommonandseriouseffectsofaging.Fattydepositsbuildupinbloodvesselwallsandnarrowthepassagewayforthemovementofblood.Theresultingcondition,calledatherosclerosisoftenleadstoeventualblockageofthecoronaryarteriesanda“heartattack〞.2020/11/42

2020/11/43Since1900,CADhasbeentheNo.1killerintheUnitedStateseveryyearbut1918.Nearly2,600AmericansdieofCADeachday,anaverageof1deathevery33seconds.CADclaimsmoreliveseachyearthanthenext5leadingcausesofdeathcombined,whicharecancer,chroniclowerrespiratorydiseases,accidents,diabetesmellitus,influenzaandpneumonia.Almost150,000AmericanskilledbyCADeachyearareunderage65.Betyoudidn'tknow....2020/11/44INCHINAFrom1984~1998,themortalityratehasrisen.CADhasbeentheNo.3killerinChina.In2003,theprevalencerateofCADis4.6‰In2004,themortalityrateofCADis46.27/100thousand.Thisrateislowerthantheratein2000Newtrend:thepatientsarebecomemoreandmoreyounger,from1984~1998,themortalityrateofyoungmankindhaslargelyrisen,theextentreachto154%

dataiscomefromTheChineseCardiovascularDiseasereport20052020/11/45

ThesecelebritiesarealldiedofCAD.mostofthemarenotveryold.Theredeathevokedpeople’smoreattentiontoCAD2020/11/46THERISKHypertensionSmokingAbnormityofbloodlipidObesityoroverweightAbnormityofbloodsugarUnhealthylifestyle2020/11/47RiskFactorsUncontrollableSexHereditaryRaceAgeControllableHighbloodpressureHighbloodlipidSmokingPhysicalactivityObesityDiabetesStressandanger2020/11/48SignsandSymptomsNone:Thisisreferredtoassilentischemia.BloodtoyourheartmayberestrictedduetoCAD,butyoudon’tfeelanyeffects.Chestpain:Ifyourcoronaryarteriescan’tsupplyenoughbloodtomeettheoxygendemandsofyourheart,theresultmaybechestpaincalledanginapectorisShortnessofbreath:SomepeoplemaynotbeawaretheyhaveCADuntiltheydevelopsymptomsofcongestiveheartfailure-extremefatiguewithexertion,shortnessofbreathandswellingintheirfeetandankles.Heartattack:Resultswhenanarterytoyourheartmusclebecomescompletelyblockedandthepartyofyourheartmusclesfedbythatarterydies.Signs&SymptomsNoneChestPainShortnessOfBreathHeartAttack2020/11/49Electrocardiogram：wecanseetheECGsignsofmyocardialischemiaorinjury.ThisisvaluableforourdiagnosesCoronaryAngiography:thisisaveryusefultest,theresultwouldbethekingstandardforthediagnoses.ItalsocandefinitudethepathologicalarteriesBloodtests:usedtoevaluatekidneyandthyroidfunctionaswellastocheckcholesterollevelsandthepresenceofanemia.ChestX-ray:showsthesizeofyourheartandwhetherthereisfluidbuilduparoundtheheartandlungs.Echocardiogram:showsagraphicoutlineoftheheart’smovementTestsInclude2020/11/410Manypeopleareabletomanagecoronaryarterydiseasewithlifestylechangesandmedications.Otherpeoplewithseverecoronaryarterydiseasemayneedangioplasty(PCI)orsurgery(CABG).Treatment2020/11/411Treatment(continued)1)Stenting

astentisintroducedintoabloodvesselonaballooncatheterandadvancedintotheblockedareaofthearterytheballoonistheninflatedandcausesthestenttoexpanduntilitfitstheinnerwallofthevessel,conformingtocontoursasneededtheballoonisthendeflatedanddrawnbackThestentstaysinplacepermanently,holdingthevesselopenandimprovingtheflowofblood.2020/11/412surgicalTreatment(continued)Bypasssurgeryhealthybloodvesselisremovedfromleg,armorchestbloodvesselisusedtocreatenewbloodflowpathinyourheartthe“bypassgraft〞enablesbloodtoreachyourheartbyflowingaround(bypassing)theblockedportionofthediseasedartery.Theincreasedbloodflowreducesanginapectorisandtheriskofheartattack.2020/11/413ConventionalCABG

〔internationalrecognition〕1onearterygraft(leftinternalmammaryarteryorleftsubclavianartery)2othersareveinGrafts(greatsaphenousvein)2020/11/414ThebestgraftforCABG—ITAITA〔internalthoracicartery〕isthebestgraftandincommonuse.Datashows,10yearsafteroperation,90%patients’ITAgraftsarestillpatencyITAcanrisethelivability,decreasetheheartattackandre-operationSTSDatabaseshows,inAmerican,88%patientsuseoneITA;InEngland,therateis90%;Inourhospital(XiangYahospital),therateisalso90%.

oneITAmustbeused!2020/11/415BITAORALLARTERIALGRAFTSomehospitalusingtwoITAs.DoseitbetterthansingleITA(conclusion)

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

It'sbetterforyoungpatientstouseBITA!Thiswayisnotaroutine!2020/11/416SITAvsBITALivability7years10years15years20yearsSITA87785837BITA89816750AnnThoracSurg2004；78：2005-142020/11/417Operativemethods

On-pumpCABG70-80%Off-pumpCABG20-30%Difference：whiletheheartisarrestedandusecardiopulmonarybypassornotwhenoperating2020/11/418

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?2020/11/419Off-pumpONPUMPTechnicaldifficultyissmallDoctorscangraspthisoperativewayfastthegraftscanbepatencyforlongtimeafteroperationEasytooperatingonthecircumflexartery

Maybealotofgrafts

MaybeaLittlebleedingRenalinsufficiencymaybeseldom

Short-termneuralfunctioninjurymaybeseldomThenumberofdaysinhospitalmaybesmall

(Circulation