外科血运重建治疗缺血性心脏病合并左心功能不全的远期效果分析  

Long-term outcome of surgical revascularization in patients with ischemic heart disease and left ventricular dysfunction

作　　者：王嵘[1] 高长青[1] 肖苍松[1] 吴扬[1] 任崇雷[1] 龚志云[1] 王瑶[1] 刘国鹏[1] 王明岩[1] 

机构地区：[1]解放军总医院心血管外科,北京100853

出　　处：《中华医学杂志》2016年第15期1178-1182,共5页National Medical Journal of China

摘　　要：目的 总结外科血运重建治疗缺血性心脏病（IHD）合并左心功能不全（LVD）患者的远期结果并分析影响远期生存的危险因素.方法 解放军总医院心血管外科2003年1月至2013年7月共2 132例缺血性心脏病患者接受冠状动脉旁路移植手术治疗,其中318例患者合并LVD[左室射血分数（LVEF）≤50％）].男266例,女52例,年龄36 ～83（63 ±9）岁.收集患者围术期资料及随访结果,以cox比例风险模型对影响长期生存的危险因素进行回归分析.结果 318例患者手术死亡6例,手术死亡发生率1.9％.术后随访1 ～ 128（45.5 ±32.4）个月,25例失访,随访率92.0％.全因死亡42例（14.6％）,再次心衰入院42例（14.6％）,再发心绞痛或心肌梗死39例（13.6％）,再次再血管化10例（3.5％）,脑血管意外5例（1.7％）,5年生存率85.6％.以全因死亡为终点事件,采用cox比例风险模型进行多因素分析,术前LVEF（HR=0.943,95％ CI：0.893 ～0.995,P=0.031）和围手术期使用主动脉球囊反搏（IABP）（HR=2.509,95％ CI：1.051 ～ 5.992,P=0.038）是影响术后长期生存的危险因素.术前重度LVD患者（LVEF≤35％,47例）与轻中度LVD患者（35％＜LVEF≤50％,271例）5年生存率差异有统计学意义（70.4％比86.1％,P=0.025）.结论 术前LVEF和围手术期使用IABP是影响外科血运重建治疗IHD合并LVD患者远期生存的重要因素,LVEF严重减退者远期生存率显著低于LVEF轻中度减退患者,围手术期使用IABP者术后全因死亡增加.Objective To analyze the long-term results and risk factors of surgical revascularization in patients with ischemic heart disease （IHD） and left ventricular dysfunction （LVD）.Methods From January 2003 to July 2013,2 132 patients underwent coronary artery bypass grafting （CABG） in our institution.Among them,318 patients with LVD[left ventricular ejection fraction （LVEF） ≤ 50％] were included in the final study.There were 266 male and 52 female patients with age from 36 to 83 （63 ± 9） years old.76 patients underwent off-pump CABG （OPCAB） and 242 patients underwent conventional CABG （CCABG）.Risk factors,perioperative results and follow-up data were collected and analyzed with cox hazard ratio model.Results Among 318 patients,6 cases died of the operation with a hospital mortality of 1.9％.With follow-up time from 1 to 128 （45.5 ± 32.4）months,25 patients were lost of follow-up,causing a follow-up rate of 92.0％.Among the 287 cases with long-term follow-up results,all-cause death,cardiogenic death and re-hospitalization due to heart failure were 14.6％ （42/287）,5.9％ （17/287）,14.6％ （42/287）,respectively.Re-revascularization rate,recurrent angina and myocardial infarction rate and cerebral incidence were 3.5％ （10/287）,13.6％ （39/287）,1.7％ （5/287）,respectively.The fiveyear survival rate was 85.6％.With all-cause death as the endpoint,preoperative LVEF （HR =0.943,95％CI：0.893-0.995,P=0.031） and perioperative implantation of IABP （HR =2.509,95％ CI：1.051-5.992,P =0.038） emerged as the risk factors that affected the long term survival.The five-year survival rate of patients with severe LVD （LVEF ≤ 35％） was significantly lower than that of patients with mild to moderate LVD （35％ ＜ LVEF≤50％） （70.4％ vs 86.1％,P =0.025）.Conclusions Preoperative LVEF and perioperative implantation of IABP had adverse effect on long-term survival of patients with IHD and LVD undergoing surgical revascularization.The long-term surviva

关 键 词：冠状动脉分流术 心肌缺血 心力衰竭 危险因素 

分 类 号：R654.2[医药卫生—外科学]