低左心室射血分数冠心病患者冠状动脉旁路移植术
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Coronary Artery Bypass Grafting in Patients with Low Left Ventricular Ejection Fraction
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    目的总结低左心室射血分数(≤0.40)冠心病患者冠状动脉旁路移植术的手术疗效。方法回顾性分析63例低左心室射血分数(≤0.40)冠心病患者冠状动脉旁路移植术,其中男45例,女18例。所有患者采用体外循环下冠状动脉旁路移植术,搭桥数2~6支/人,平均3.43±1.90支/人。对手术方法、主要并发症和术后处理进行分析总结。结果二次开胸1例(1.6%),低心排综合征5例(7.9%),应用主动脉内球囊反搏3例(4.8%),反复发作房颤6例(9.5%),脑合并症1例(1.6%),肝功能不全2例(3.2%),肾功能不全2例(3.2%),肺功能不全3例(4.8%),胸腔积液7例(11.1%)。死亡1例(1.6%),其余患者康复出院。术后出院患者左心室射血分数、左心室舒张末内径及心功能均有显著性改善。结论合理的选择患者,成熟的手术技术,良好的心肌保护,停机困难者主动脉内球囊反搏的尽早应用及术后处理的加强是提高低左心室射血分数冠心病患者冠状动脉旁路移植术疗效的重要措施。

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    Aim To summarize the results of coronary artery bypass grafting(CABG) for the patients with low left ventricular ejection fraction(LVEF).Methods A retrospective study was carried out.63 cases with low LVEF(≤0.40) underwent CABG,45 males and 18 females.Cardiopulmonary bypass(CPB) was applied in CABG.Surgical technique,complications,LVEF,left ventricular end-diastolic diameter(LVEDD),heart function and post-operative treatment were analyzed.Results Early post-operative complication included:Re-open in 1 case(1.6%),LCOS in 5 cases(7.9%),IABP used in 3 cases(4.8%),repeatedly atrial fibrillation in 6 cases(9.5%),complication of CNS in 1 case(1.6%),hepatic dysfunction in 2 cases(3.2%),renal insufficiency in 2 cases(3.2%),respiratory insufficiency in 3 cases(4.8%),pleural effusion in 7 cases(11.1%) and death in 1 case(1.6%).The others had favorable outcomes.There were significant improvement in mean LVEF,LVEDD and NYHA class postoperatively(P<0.01).Conclusions Suitable adaptative disease,excellent surgical technique,advanced myocardial protection,IABP applied early when weanning from pump is difficult and enhancing post-operative treatment can significantly improve the results of CABG for the patients with low LVEF.

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庾华东,陶凉,陈绪发.低左心室射血分数冠心病患者冠状动脉旁路移植术[J].中国动脉硬化杂志,2009,17(3):232~234.

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  • 收稿日期:2009-01-04
  • 最后修改日期:2009-03-05
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