摘要
目的 总结并分析左心室收缩功能低下冠心病病人行冠状动脉旁路移植手术(CABG)的中、远期效果。方法 34例左心室射血分数(LVEF)低于0 30且不伴左心室室壁瘤的冠状动脉粥样硬化心脏病病人行CABG ,平均年龄(5 8 0±9 4 )岁。冠状动脉造影显示LVEF为0 15～0 30 ,平均0 2 7±0 0 4 ,其中2支病变3例,3支病变31例(包括左主干病变4例)。超声心动显示左心室舒张末直径(LVDD)平均为(6 1 5±8 9)mm ,LVEF平均0 2 8±0 0 7。心功能分级平均为2 9±0 7。体外循环下手术2 6例,非体外循环常温手术(OPCAB) 8例。每例旁路移植2～6支,平均(3 9±0 9)支。随访率94 1% ,随访时间平均(3 5±1 9)年。结果 无手术死亡。早期主要并发症为心功能不全。所有病人心绞痛症状明显减轻,左心室舒张末直径平均(5 5 2±7 1)mm ,LVEF平均0 4 7±0 11。心功能分级平均1 9±0 3。以上指标与术前进行统计学比较,差异均具统计学意义。随访3年生存率为91 9% ,5年生存率为85 7%。5年免除心绞痛为81 3% ,心功能分级为1～3级,平均1 4±0 6。结论 伴左心室收缩功能低下的CABG病人的中、远期疗效满意,充分的术前准备是手术成功关键。
Objective To evaluate the mid- and long-term results of coronary artery bypass grafting （CABG） in patients with severe left ventricular systohe dysfunction. Methods Between January 1988 and December 2002, 34 cases with left ventrieular ejection fraction （LVEF） less than 0.30 underwent CABG. They were aged 41 to 73 years [mean, （58.0 ± 9.4） years], and 30 of them were male. Coronaxy angingraphy revealed LVEF was 0.15 to 0.30（mean, 0.27 ± 0.04）, and triple-vessel disease in 31 cases, and left main stem disease in 4. Preoperative echoeardiographie examinations revealed a mean of left ventrieular diastolic dimension （LVDD） （61.5 ±8.9） mm and LVEF 0.28± 0.07. New York Heart Association （NYHA） class was （2.9 ± 0.7）. Off-pump CABG was performed in 8 eases. The number of grafts used ranged from 2 to 6 （3.9 ± 0.9）. 32 patients （94.1% ） were followed up for 3.5 years （with 7.2 years maximum）. Results No patients died in hospital. Heart failure as the main postoperative complications were observed in 5 （14.7%） patients. Postoperative echocardiographic examinations revealed a mean LVDD of （55.2 ±7.1 ） mm and LVEF of 0.47 ±0.11. NYHA class wasl.9 ±0.3 postoperatively. In the follow-up period [ mean （3.5 ± 1.9） years], 3 patients died. The survival rates were 91.9 % at 3 years and 85.7 % at 5 years. Functional status improved significant in left ventricular vendiastolic diameter and left ventricular ejection fraction. There was significant improvement in mean NYHA from class 2.9± 0.7 to 1.4 ±0.6 postoperatively. 26 survivors （81.3%） are free of angina. Conclusion Observatians suggest that CABG may offer a better quality of life in patients with peorventricular systolic function in mid- and long-term follow-up. Preoperative management was the key point of the survival advantage.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2005年第3期139-141,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
