非体外循环冠状动脉旁路移植术在冠心病并发左心室功能不全患者中的应用价值  

Application value of off-pump coronary artery bypass grafting in patients with coronary heart disease complicated with left ventricular dysfunction

作　　者：黄骏[1] 王志维[1] 吴红兵[1] 李罗成[1] 

机构地区：[1]武汉大学人民医院心血管外科,武汉市430060

出　　处：《广西医学》2016年第3期318-320,共3页Guangxi Medical Journal

基　　金：国家自然科学基金(81570428)

摘　　要：目的评价非体外循环冠状动脉旁路移植术(OP-CABG)在冠心病并发左心室功能不全患者中的应用价值。方法选择冠心病并发左心室功能不全患者111例,术前左心室射血功能(LVEF)均<40%,按治疗方式的不同分为A组及B组,A组接受OP-CABG,B组接受并行体外循环下心脏不停跳冠状动脉旁路移植术(On PBH-CABG)。比较两组围术期临床资料。结果两组均死亡2例。两组术后呼吸功能不全、中枢神经功能障碍的发生率比较,差异均无统计学意义(P>0.05),但A组心肌梗死及肾衰竭发生率低于B组(P<0.05)。A组使用主动脉球囊反搏比例、围术期输血量、呼吸机辅助呼吸时间、重症监护室停留时间及住院费用均少于B组(P<0.05)。结论对于LVEF<40%的冠心病并发左心室功能不全患者,OP-CABG优于On PBH-CABG,其术后并发症少,但远期预后还需进一步研究证实。Objective To evaluate the application value of off-pump coronary artery bypass grafting （OP-CABG） in patients with coronary heart disease complicated with left ventricular dysfunction. Methods A total of 111 patients with coronary heart disease complicated with left ventricular dysfunction were enrolled. The left ventricular ejection fractions （LVEF） of all patients were less than 40%. The patients were divided into Group A and Group B according to the therapeutic approach. Group A received OP-CABG and Group B received on-pump beating-heart coronary artery bypass grafting （ OnPBH-CABG ）. The periopeartive clinical data were compared between two groups. Results Death occurred in two cases of each group. There was no statistical difference in the incidence of respiratory dysfunction or dysfunction of central nervous system between two groups（P 〉 0.05 ）. The incidences of myocardial infarction and renal dysfunction in Group A were lower than those in Group B （ P 〈 0.05 ）. The proportion of iutro-aortic baUoon pump application, periopearive transfusion volume, the duration of assisted respiration with mechanical ventilation, ICU stay and hospital cost were less in Group A compared to those in Group B （ P 〈 0.05 ）. Conclusion For the patients with coronary heart disease complicated with left ventricular dysfunction whose LVEFs are less than 40% , OP-CABG is superior to OnPBH-CABG,and has less complications. But the long-term prognosis of OP-CABG needs to be proved by further survey.

关 键 词：冠心病 左心室功能不全 非体外循环冠状动脉旁路移植术 体外循环下心脏不停跳冠状动脉旁路移植术 

分 类 号：R654[医药卫生—外科学]