不同手术策略治疗冠心病合并左室功能减退的效果分析  

Analysis of the effects of different surgical strategies on treating left ventricular dysfunction in patients with coronary heart disease

作　　者：王悦[1] 程兆云[1] 赵子牛[1] 孙俊杰[1] 胡俊龙[1] 轩继中 任培军 Wang Yue;Cheng Zhaoyun;Zhao Ziniu;Sun Junjie;Hu Junlong;Xuan Jizhong;Ren Peijun(Department of Cardiovascular Surgery,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心血管外科,河南郑州450003

出　　处：《河南医学研究》2018年第3期388-391,共4页Henan Medical Research

基　　金：国家临床重点专科建设项目(2011);河南省科技发展计划项目(132102310190)

摘　　要：目的对比分析非体外循环冠状动脉搭桥术(OPCABG)与体外循环下心脏不停跳冠状动脉搭桥术(ONPBH)治疗冠心病合并左室功能减退的近期效果,探讨左室功能减退患者的手术策略选择。方法回顾性分析2014年1月至2016年12月河南省人民医院收治的拟行手术治疗的73例冠心病合并左室功能减退患者,根据手术方法分为OPCABG组(40例)和ONPBH组(33例),对比分析两组手术相关指标、手术前后的左室射血分数(LVEF)及左室舒张末期内径(LVEDd)变化。结果 ONPBH组桥血管数量多于OPCABG组,手术时间、呼吸机辅助时间及ICU停留时间均长于OPCABG组,总引流量、术后红细胞、术后血浆总量及主动脉内球囊反搏(IABP)使用率均大于OPCABG组,差异有统计学意义(P均<0.05)。术前两组LVEF和LVEDd水平比较,差异无统计学意义(P>0.05);术后1个月,两组LVEF和LVEDd较术前均改善,差异有统计学意义(P<0.05),组间比较,差异无统计学意义(P>0.05)。结论 OPCABG与ONPBH术治疗冠心病合并左室功能减退均可改善患者心功能,相较ONPBH,OPCABG能缩短手术时间、呼吸机辅助时间及ICU停留时间,减小手术创伤。Objective To compare the short-term effects of off-pump coronary artery bypass grafting(OPCABG)and on-pump beating-heart coronary artery bypass grafting(ONPBH)on left ventricular dysfunction in patients with coronary heart disease undergoing cardiopulmonary bypass,and explore the surgical strategies for patients with left ventricular dysfunction.Methods Seventy three patients with coronary artery disease and left ventricular dysfunction admitted to Henan Provincial People’s Hospital from January of 2014 to December of 2016 were retrospectively analyzed.According to the surgical methods,they were divided into two groups:OPCABG group(forty cases)and ONPBH group(thirty three cases).The surgery-related indicators and changes in ECG before and after surgery were compared between two groups.Result The number of vessels in the ONPBH group was more than that in the OPCABG group.The operation time,ventilator-assisted time and ICU residence time were longer in the OPCABG group than OPCABG group.The differences of total drainage volume,postoperative erythrocyte,total postoperative plasma volume and IABP utilization rate between two groups were statistically significant(P<0.05).At one month after operation,LVEF and LVEDd in both groups were significantly improved compared with these before operation(P<0.05).There was no significant difference between two groups(P>0.05).Conclusion Both of off-pump coronary artery bypass grafting and on-pump beating-heart coronary artery bypass grafting can benefit the patients with left ventricular dysfunction.Compared with on-pump beating-heart coronary artery bypass grafting,off-pump coronary artery bypass grafting can shorten the operation time,the duration of the ventilator time,the lengths of the ICU stays,and reduce the surgical trauma.

关 键 词：冠心病 左心室 心功能不全 冠状动脉搭桥术 

分 类 号：R654.2[医药卫生—外科学]