非体外循环冠状动脉旁路移植术在低射血分数冠心病患者中的应用体会  

Application of off-pump coronary artery bypass grafting in patients with coronary heart disease with low ejection fraction

作　　者：吕丽萍 齐恒田[1] 卢峰 王可强 刘诫 师启众[1] 樊宏哲[1] 王飞 李温斌[2] LV Liping;QI Hengtian;LU Feng;WANG Keqiang;LIU Jie;Sill Qizhong;FAN Hongzhe;WANG Fei;LI Wenbin(Department of Cardio-Thoracic Surgery, The Third Affiliated Hospital of Xinxiang Medi- cal University, Xinxiang 453000, Chin)

机构地区：[1]新乡医学院第三附属医院心胸外科,4530001 [2]首都医科大学附属安贞医院心外科

出　　处：《心肺血管病杂志》2018年第4期333-336,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨非体外循环冠状动脉旁路移植术(OPCABG)在低射血分数冠心病患者中的应用体会。方法:对2015年11月至2017年3月,我院心胸外科行OPCABG手术的41例低射血分数的冠心病患者进行回顾性分析。患者均在全麻下行OPCABG手术,测定术前与术后8h血肌酐(SCr)、血尿素氮(BUN)、血小板(PLT)并进行比较,记录手术前、术后1周和3个月的左心室射血分数(EF)、左心室收缩期末内径(LVSD)和左心室舒张期末内径(LVDD),将结果进行比较;部分患者术后因低心排而应用主动脉内球囊反搏(IABP),监测使用前后血流动力学指标,如心率(HR)、心脏指数(CI)、收缩压、舒张压、中心静脉压(CVP)。结果:术后8h的Cr、BUN、PLT与术前比较无明显改变(P>0.05)。术后1周EF与术前相比有所提高(P<0.05),但LVSD和LVDD无明显变化(P>0.05),但术后3个月后复查EF值与术后1周相比明显提高(P<0.05),LVDD明显减小(P<0.05),而LVSD未见明显变化(P>0.05);术后部分患者因出现低心排而使用IABP,2h后舒张压、平均动脉压均增高,心率减慢,中心静脉压降低,心排血量及心脏指数增高(P<0.05)。术后早期死亡2例(4.9%),分别为低心排综合征1例、多器官衰竭1例。术后39例康复出院。随访3个月,1例(2.6%)因脑血管意外死亡。结论:低EF冠心病患者实施OPCABG后近期效果显著,可明显提高EF,减小LVDD,且部分患者使用IABP 2h后可明显改善血流动力学指标进而保护心肌,但远期结果仍有待进一步观察。Objective： To investigate the application of off-pump coronary artery bypass grafting（ OPCABG） in patients with low ejection fraction coronary heart disease. Methods： A retrospective analysis was performed on 41 patients with coronary artery disease with low ejection fraction score during OPCABG surgery from November 2015 to March 2017 in our hospital. Patients underwent OPCABG under general anesthesia. Serum creatinine（ SCr）,blood urea nitrogen（ BUN） and platelet（ PLT） were measured before and 8 hours after operation. The ejection fraction（ EF）,Left ventricular systolic diameter（ LVSD） and left ventricular end diastolic diameter（ LVDD） in the first week and the third month after operation. The left ventricular end diastolic diameter Result Some patients were treated with intra-aortic balloon pump（ IABP） due to low cardiac output after operation. The hemodynamic parameters such as heart rate（ HR）,cardiac index（ CI）,systolic pressure（ SP）,diastolic pressure（ DP） and central venous pressure（ CVP）. Results： There was no significant change of Cr,BUN and PLT at 8 hours after operation compared with that before operation（ P〈0. 05）. The EF of one week after operation was significantly higher than that before operation（ P〈0. 05）,but LVSD and LVDD had no significant change（ P〈0. 05）,but the EF after three months postoperatively was significantly higher than that of one week after operation（ P〈0. 05）,LVDD decreased significantly（ P〈0. 05）,while LVSD had no significant change（ P〈0. 05）. In the postoperative part,IABP was used because of low cardiac output,diastolic blood pressure after 2 h and mean arterial pressure were all increased,Heart rate decreased,central venous pressure decreased,cardiac output and cardiac index increased（ P〈0. 05）. Two patients died early after operation（ 4. 9%）,one was low cardiac output syndrome and one was multiple organ failure. Postoperative 39 patients were discharged. During 3 months foll

关 键 词：非体外循环冠状动脉旁路移植术 低射血分数 冠心病 

分 类 号：R54[医药卫生—心血管疾病]