不同血运重建方式治疗冠状动脉粥样硬化性心脏病合并左心室功能不全的早期疗效比较  

Comparison of early outcomes of two kinds of revascularization on the patients with coronary heart disease complicated with left ventricular dysfunction

作　　者：许明发 王帅飞 苏国宝[1] 周朝元[1] 韩培立[1] XU Ming-fa;WANG Shuai-fei;SU Guo-bao;ZHOU Chao-yuan;HAN Pei-li(Department of Cardiovascular Surgery,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院心血管外科,河南卫辉453100

出　　处：《新乡医学院学报》2018年第11期1018-1022,共5页Journal of Xinxiang Medical University

摘　　要：目的比较体外循环下心脏不停搏冠状动脉旁路移植术(On-PBH)与非体外循环心脏不停搏冠状动脉旁路移植术(OPCABG)治疗冠状动脉粥样硬化性心脏病(CHD)合并左心室功能不全(LVD)患者的早期疗效。方法回顾性分析2015年1月至2017年6月新乡医学院第一附属医院收治的88例CHD合并LVD患者的临床资料,其中行On-PBH 37例(On-PBH组),行OPCABG 51例(OPCABG组)。比较2组患者血运重建结果、手术时间、呼吸机辅助时间、心脏外科重症监护病房(CSICU)入住时间、术中输血量、主动脉内球囊反搏术(IABP)置入率、术后并发症发生率、术后血管活性药物应用情况、术后住院时间、住院费用、术后3个月内心绞痛复发率、心功能恢复情况。结果 2组患者平均移植血管数比较差异无统计学意义(P> 0. 05)。On-PBH组患者手术时间、呼吸机辅助时间、CSICU时间、术后住院时间长于OPCABG组(P <0. 05),术中输血量、IABP置入率、术后并发症发生率、住院费用高于OPCABG组(P <0. 05); 2组患者术后血管活性药物应用率、术后3个月内心绞痛复发率比较差异均无统计学意义(P> 0. 05)。2组患者术前左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD)比较差异无统计学意义(P> 0. 05),术后3个月LVEF较术前显著增高(P <0. 01),LVEDD较术前显著降低(P <0. 01)。术后3个月,OPCABG组患者LVEF高于On-PBH组(P <0. 05),LVEDD低于On-PBH组(P <0. 05); LVEF≤40%者术后3个月与术前LVEF差值、LVEDD差值高于40%<LVEF≤50%者(P <0. 01,P <0. 05)。结论 On-PBH和OPCABG均可明显改善CHD合并LVD患者的早期心功能,但是OPCABG较On-PBH早期疗效更显著;左心室功能越差的患者从血运重建治疗中获益越大。Objective To investigate the early outcomes of on-pump beating heart coronary artery bypass grafting（On-PBH） and off-pump coronary artery bypass grafting （OPCABG） on the patients with coronary atherosclerotic heart disease（CHD） complicated with left ventricular dysfunction（LVD）.Methods The clinical data of 88 patients admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2015 to June 2017 with CHD complicated with LVD were retrospectively reviewed.Among these patients,37 cases underwent On-PBH（On-PBH group） and 51 cases received OPCABG（ OPCABG group）.The revascularization treatment results,operation time,ventilator assist time,time in cardiosurgery intensive care unit （CSICU）,intraoperative blood transfusion volume,intra-aortic balloon counter pulsation （IABP） placement rate,postoperative complication rate,postoperative vasoactive drug application,postoperative hospital stay,hospitalization cost,recurrence rate of angina within 3 months after surgery,and cardiac function recovery were compared between the two groups.Results There was no significant difference in the number of grafted vessels between the two groups（ P 〉0.05）.In the On-PBH group,the operation time,ventilator assist time,time in CSICU,and postoperative hospital stay were longer than those in the OPCABG group（ P 〈0.05）;the intraoperative blood transfusion volume,IABP placement rate,postoperative complication rate,and hospitalization cost were higher than those in the OPCABG group（ P 〈0.05）.There was no significant difference in the rate of postoperative vasoactive drugs and the recurrence rate of angina within 3 months after surgery between the two groups （ P 〉0.05）.There was no significant difference in the preoperative left ventricular ejection fraction （LVEF） and left ventricular end diastolic dimension （LVEDD） between the two groups（ P 〉0.05）.At 3 months after operation,the LVEF was significantly higher than that before the operation（ P 〈0

关 键 词：冠状动脉粥样硬化性心脏病 左心室功能不全 体外循环下心脏不停搏冠状动脉旁路移植术 非体外循环冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]