我国首例动力性心肌成形术成功报告  

Dynamic cardiomyoplasty:first successful clinial casein China

作　　者：王天佑[1] 王志成[1] 林昌锦[1] 李科望[1] 潘浩[1] 李树人[1] 吕可洁[1] 陈淑恩[1] 李冬梅 韩鸥 王安安[1] 陈道荫[1] 

机构地区：[1]首都医科大学附属北京友谊医院胸心血管外科

出　　处：《中华外科杂志》1995年第1期42-45,共4页Chinese Journal of Surgery

摘　　要：对我国首例成功施行动力性心肌成形术的患者进行报道。本例患者为扩张性心肌病，慢性心力衰竭，心功能Ⅲ级。手术中游离转移左侧背阔肌，包裹心室，植入Ｍｅｄｔｒｏｎｉｃ心脏肌肉刺激系统。术后２周后开始进行骨骼肌序贯式渐进性电刺激。术后四个月心功能改善为Ⅰ级。超声、核素扫描、心导管检查显示血液动力学指标有明显改善，核素扫描ＬＶＥＦ由１５％增加为２４％，ＳＶＩ由２１．７ｍｌ／ｂｅａｔ／ｍ￣２增加至５０．６ｍｌ／ｂｅａｔ／ｍ￣２；ＣＩ由２．６９Ｌ／ｍｉｎ／ｍ￣２增加到３．５９Ｌ／ｍｉｎ／ｍ￣２。作者对有关病例选择、手术操作、围手术期处理及疗效评价等问题进行了讨论。AbstractA 35-year-old man with chronic heart failure(NYHA Class Ⅲ)caused by dilated cardiopathy wasselected for dvnamic cardiomyoplasty.The procedureswere completed in one stage. The left latissimus dorsimuscle was mobilized and wrapped around the heart.A set of medtronic cardiomyostimulator system(AMedtronic Model SP 1005A Cardiomyostimulator,twoMedtronic Model SP 5528 intramuscular leads,andtwo medtronic Model 5701-35 Cardiac screw-in leads)was implanted.The postoperative sequential progres-sive skJetal muscle electrostimulation was started twoweeks after cardiomyoplasty. The final electrostimu-lated parameters were:6 pulses,amplitude 2.75V,synchronization delay 75ms,pulse width210us,syn-chronization ratio 2:1,frequency 30Hz ’stimulationduration 185ms.The patient recovered very well.Af-ter four months ,patient’s status improved to NYHAClass Ⅰ.Echocardiography,MUGA,and catheteriza-tion studies showed a significant improvement inhemodynamic parameters(MUGA LVEF increasedfrom 15%to 24%,SVI increased from 21.7ml/beat/m￣2 to 50. 6ml/beat/m￣2;CI increased from2.699L/min/m￣2to 3.59L/min/m￣2.

关 键 词：心肌病 外科手术 成形术 

分 类 号：R654.2[医药卫生—外科学] R542.205[医药卫生—临床医学]