冠状动脉旁路移植术患者左心室舒张功能的初步评估  

Evaluation of left ventricular diastolic function in patients undergoing off pump coronary artery bypass grafting

作　　者：史宏伟[1] 施韬[1] 葛亚力[1] 魏海燕[1] 石莉[1] 朱健明[1] 陈鑫[1] 

机构地区：[1]南京医科大学附属南京第一医院麻醉科,210006

出　　处：《临床麻醉学杂志》2007年第6期445-447,共3页Journal of Clinical Anesthesiology

基　　金：留学人员申请人事部科研择优经费;宁人字2004[83]文

摘　　要：目的评价冠状动脉旁路移植术(CABG)患者左心室舒张功能(LVDF)。方法采用经食管超声心动图(TEE)技术观察46例不停跳CABG(OPCABG)患者手术前后LVDF的变化。结果与术前比较,术后经二尖瓣尖脉冲多普勒血流频谱(TMF)的舒张早期充盈波(E波)和舒张晚期充盈波(A波)流速显著加快(P<0.01);E波血流时间积分(VTIE)和A波血流时间积分(VTIA)显著增加(P<0.05或P<0.01);E波减速时间(DT)和加速时间(AT)显著缩短(P<0.05或P<0.01);而E/A、A波间期和舒张早期充盈分数(RFF)值差异无统计学意义。术后经左上肺静脉血流频谱(PVF)的S、D和AR波的流速显著加快(P<0.01);而S/D、AR波间期和AR-A(AR波间期与A波间期之差)差异无统计学意义。面积减少分数(FAC)和心排血量(CO)显著增加(P<0.01)。PCWP与AR波直线回归方程:PCWP=2.6+0.4AR。结论CABG患者普遍存在以左心室松弛功能减低为主的舒张功能不全,术后早期收缩功能迅速改善,但舒张功能不全依然存在。TEE可区分心脏的收缩和舒张功能。Objective To evaluate the left ventricular diastolic function of the patients undergoing off pump coronary artery bypass graft surgery （OPCABG）. Methods The changes of perioperative left ventricular diastolic functions were studied in 46 patients undergoing OPCABG by transesophageal echocardiography （TEE）. Results Compared with those before operation, the patients after surgery had higher TMF E wave velocity and A wave velocity（P〈0.01）, higher VTIE and VTIA （P〈0.05 or P〈0.01） ,and shorter DT and AT（P〈0.05 or P〈0.01） ,but E/A ratio, duration of A wave and RFF were not significantly changed. Meanwhile the patients had an higher PVF systolic wave velocity（S） （P〈0.01）, diastolic wave velocity（D） （P〈0.01） and AR wave velocity （P〈0.01） ,but S/D ratio, duration of AR wave and margin between duration of AR and A were not significantly different. Left ventricular fractional area change（FAC）and CO were higher than those before operation（P〈0.01）. The regresstion linear equation for PCWP and AR was PCWP= 2.6＋0.4 AR. Conclusion The patients undergoing CABG surgery have predominant left ventricle diastolic dysfunction secondary to a decreased relaxation dysfunction, which is still present early after operation although cardiac systolic function is improved promptly after revascularization. TEE can be used to evaluate cardiac systolic and diastolic function separately.

关 键 词：冠状动脉旁路移植术 左心室舒张功能 经食管超声心动图 

分 类 号：R654.2[医药卫生—外科学]