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冠心病合并左心功能不全患者冠状动脉旁路移植术效果 |
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胡盛寿 张怀军 吴清玉 朱晓东 许建屏
【摘要】 目的 总结151例左室射血分数(LVEF)＜45%患者的冠状动脉旁路移植术(CABG)效果。方法 单纯CABG组61例，平均LVEF(40.8±3.7)%，平均塔桥3.6支；CABG合并其它手术组90例，平均LVEF(34.4±7.1)%，平均搭桥1.8支，合并手术包括室壁瘤切除或成形87例，瓣膜置换3例。结果 两组分别死亡2例和6例，心律失常和术后低心排是手术死亡的主要原因。平均随访34个月，随访率为92%，两组各死亡2例，其中3例与心脏因素有关。两组LVEF分别为(55.6±7.3)%和(50.4±11.4)%，较术前有明显提高(P<0.01)。术前心绞痛症状基本消失。早晚期病死率没有明显差异(P>0.05)。结论 CABG对伴有左心功能不全的冠心病患者是一种安全有效的治疗方法。移植血管应尽可能应用乳内动脉，以提高远期效果。加强围术期的处理，调整心脏的前后负荷，兼顾心肌氧需和氧耗平衡，必要时应用主动脉内球囊反搏或左室辅助(LVAD)，以提高手术效果。
【关键词】 冠状动脉疾病 心功能，左 胸廓内动脉-冠状动脉吻合术
Results of CABG in patients with left ventricular dysfunction HU Shengshou, ZHANG Huaijun, WU Qingyu, et al. Fuwai Hospital and Cardiovascular Institute , Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037
【Abstract】 Objective A series of 151 patients with LVEF less than 0.45 who underwent CABG between 1990 and 1996 were reviewed. Methods Sixty one patients with mean of LVEF 40.8% underwent isolated CABG. An average of 3.6 grafts were performed per patient. Ninety patients with mean of LVEF 34.4% underwent CABG and other cardiac procedures. An average of 1.8 grafts were performed per patient. Concomitant cardiac procedures included aneurysmectomy in 87 cases and valve replacement in 3 cases. Results There were 2 operative deaths in isolated CABG group, 6 in combined CABG group. Arrhythmia and postoperative low cardiac output syndrome were the main cause for operative deaths. The mean of follow up interval was 34 months and 92% of patients who left hospital were followed up. Two late deaths occurred in each group, 3 of which were unrelated to cardiac factors. Compared with preoperative LVEF, postoperative LVEF significantly increased (Isolated CABG: 55.6±7.3 %; Combined CABG: 50.4±11.4%). Patients with previous angina had marked improvement; nearly all were asymptomatic or minimally symptomatic. There was no difference in early and late mor[1] [2] [3] 下一页
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