非体外循环下冠状动脉旁路移植术对轻中度缺血性二尖瓣关闭不全的作用  

Effect of off-pump coronary artery bypass grafting on mild-to-moderate ischemic mitral valve regurgitation

作　　者：董明亮[1] 李清宝[1] 谭琦[1] 李德才[1] 王安彪[1] 李勇[1] 訾捷[1] 范全心[1] Dong Mingliang;Li Qingbao;Tan Qi;Li Decai;Wang Anbiao;Li Yong;Zi Jie;Fan Quanxin(Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China)

机构地区：[1]山东大学附属省立医院心脏外科

出　　处：《中国心血管杂志》2019年第3期237-240,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的评估非体外循环下冠状动脉旁路移植术(OPCABG)对轻中度缺血性二尖瓣关闭不全(IMR)的作用,以探讨最佳治疗方案。方法2011年3月至2017年12月,实施单纯OPCABG治疗冠心病合并轻中度IMR患者112例。术后7d、6个月行超声心动图检查,测定左心室舒张末内径(LVEDD)、左室射血分数(LVEF)及二尖瓣反流情况,明确二尖瓣关闭不全是否得到改善。结果112例患者均未出现死亡。3例患者术中安置主动脉球囊反搏(IABP)。术后7d、6个月时所有患者二尖瓣关闭不全均有所改善;LVEF术后7d较术前明显改善,差异有统计学意义(52.55%±3.15%比48.60%±1.74%,P<0.01);LVEDD术后7d较术前明显改善,差异有统计学意义[(5.15±1.22)cm比(5.70±1.12)cm,P<0.01];术后6个月LVEF较术后7d亦有提高,且差异有统计学意义(56.90%±2.04%比52.55%±3.15%,P<0.05);术后6个月LVEDD较术后7d亦有减小,且差异有统计学意义[(4.87±1.08)cm比(5.15±1.22)cm,P<0.05]。术后24h内13例患者CK-MB升高,48h降至正常;术后早期5例患者发生室性期前收缩,1例发生心室颤动,9例发生快速心房颤动;围术期心肌梗死和低心排血量综合征各1例;所有患者术后心绞痛症状均消失。结论冠状动脉旁路移植术能够改善缺血心肌的供血以及乳头肌的血供,从而改善左心室的收缩功能。缺血心肌血供改善后,能够获得良好的恢复,进而使心脏缩小,左心功能和二尖瓣功能得到恢复。Objective To evaluate the effect of off-pump coronary artery bypass grafting (OPCABG) on mild-to-moderate ischemic mitral valve regurgitation (IMR) and to explore the optimal treatment regimen. Methods From March 2011 to December 2017, 112 cases of coronary artery disease with mild-to-moderate IMR underwent isolated OPCABG. Echocardiography was performed 7 days and 6 months after surgery. Left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and the change of mitral valve regurgitation were measured to determine whether mitral regurgitation was improved. Results No death occurred in 112 patients. Three patients underwent intra-aortic balloon pump (IABP) during operation. The mitral insufficiency of all patients was improved at 7 days and 6 months after surgery. LVEF was significantly increased 7 days after operation than that of preoperation (52.55%±3.15% vs. 48.60%±1.74%, P <0.01). LVEDD was significantly decreased 7 days after surgery than that of preoperation [(5.15±1.22)cm vs.(5.70±1.12)cm, P <0.01]. LVEF was improved 6 months after surgery than that of 7 days after operation and the difference is significant (56.90%±2.04% vs. 52.55%±3.15%, P <0.05). LVEDD was improved 6 months after surgery than that of 7 days after operation and the difference is significant [(4.87±1.08)cm vs.(5.15±1.22)cm, P <0.05]. After operation, CK-MB of 13 patients, increased in 24 hours, and decreased to normal in 48 hours. In the early postoperative period, 5 patients developed ventricular premature beats, 1 patient developed ventricular fibrillation and 9 patients developed rapid atrial fibrillation. Perioperative myocardial infarction in 1 patient and low cardiac output syndrome occurred in 1 patient, respectively. And all the patients got rid of angina after operation. Conclusions After OPCABG, blood supply of ischemic myocardial and papillary muscles can be improved, which in turn reduce the ventricle, and improve the function of left ventricular and mitral valve.

关 键 词：冠状动脉疾病 冠状动脉旁路移植术 非体外循环下 缺血性二尖瓣关闭不全 

分 类 号：R654.2[医药卫生—外科学]