冠状动脉旁路移植术治疗缺血性心功能不全患者的远期疗效  

Long-term Results of Coronary Artery Bypass Grafting in the Treatment of Ischemic Cardiac Diseases with Heart Insufficiency

作　　者：刘盛[1] 胡盛寿[1] 王巍[1] 许建屏[1] 宋云虎[1] 孙寒松[1] 郑哲[1] 高华炜[1] 袁昕[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心血管病研究所外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2010年第3期188-191,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家科技支撑计划资助项目(2006BAI01A09);北京市科委资助项目(D0906004040391);中央级公益型科研院所基本科研资助项目(2009-2011)~~

摘　　要：目的分析缺血性心功能不全患者接受冠状动脉旁路移植术(CABG)的远期生存率和心力衰竭免除率,以评价单纯CABG治疗缺血性心功能不全患者的远期疗效。方法 1999年1月至2005年12月阜外心血管病医院收治冠心病伴左心功能不全(左心室射血分数<40%)患者239例,其中男215例,女24例;年龄32～78岁,平均年龄59.1岁。术前有心肌梗死病史193例,有心绞痛31例;心功能分级(NYHA)Ⅰ级26例,Ⅱ级106例,Ⅲ级73例,Ⅳ级34例。冠状动脉造影显示:单支血管病变10例(4.2%),2支病变35例(14.6%),3支病变194例(81.2%);术前超声心动图提示:左心室射血分数35.7%±4.6%。所有患者均接受CABG,体外循环CABG153例(64.0%),非体外循环CABG86例(35.9%);择期手术237例,急诊手术2例。同期未行心瓣膜成形或置换术、室壁瘤切除和折叠术等其他手术。结果每例移植旁路血管1～6支(3.4±1.1支)。院内死亡5例(2.09%),其中因低心排血量、循环衰竭死亡2例,发生恶性心律失常死亡1例,肾功能衰竭死亡1例,昏迷并发多器官功能衰竭死亡1例。随访216例(92.3%),随访时间5.12±1.79年;失访18例(7.7%)。随访期间死亡29例,其中心源性死亡24例,心源性死亡率1年为2.8%,5年为9.4%;发生心力衰竭40例,1年心力衰竭免除率为93.7%,5年免除率为81.8%;1年生存率为97.2%,5年生存率为89.3%。结论 CABG治疗缺血性心功能不全患者的远期疗效满意。Objective To evaluate the long-term results of coronary artery bypass grafting （CABG） in treating cardiac diseases with heart insufficiency by analyzing the long-term survival rate and heart failure exemption rate of the patients.Methods A total of 239 patients who had coronary heart disease with left heart dysfunction （LVEF40%） were enrolled in our study.Among the patients,there were 215 males and 24 females aged from 32 to 78 years old with an average age of 59.1.Before operation,193 patients had a past history of myocardial infarction and 31 had angina.According to the New York heart function assessment （NYHA）,26 patients were categorized as class Ⅰ,106 as class Ⅱ,73 as class Ⅲ and 34 as class Ⅳ.Coronary angiography showed 10 cases （4.2%） of single vessel disease,35 cases （14.6%） of double vessel disease and 194 cases （81.2%） of triple vessel disease.The result of preoperative ultrasound cardiogram showed that LVEF was 35.7%±4.6%.All patients received CABG,including 153 （64.0%） on-pump surgeries and 86 （35.9%） off-pump surgeries.Selective operation was done on 237 patients and there were 2 emergency cases.Valve repair or replacement,ventricular aneurysmectomy or aneurysm plication were not carried out during the operation.Results There were 1 to 6 （3.4±1.1） bypass grafting vessels in each case.Five （2.09%） patients died during the hospital stay,among which 2 died of low cardiac output and circulation failure,1 died of malignant arrhythmia,1 died of renal failure,and 1 died of coma with multi-organ failure.The follow-up period was 5.12±1.79 years.During the follow-up,18 patients （7.7%） were lost and 29 patients died.Among them,there were 24 cardiac deaths and the cardiac death rate at the first year and the fifth year was 2.8% and 9.4% respectively.There were 40 cases of heart failure during the follow-up period.The exemption rate of heart failure was 93.7% and 81.8% at the first year and the fifth year respectively.The survival rate was 97.2% at the first

关 键 词：冠状动脉旁路移植术 心功能不全 远期疗效 

分 类 号：R654.2[医药卫生—外科学]