心肺转流不停跳冠状动脉旁路移植术治疗冠心病合并左心功能不全的疗效研究  

The effect of on-pump beating heart coronary artery bypass grafting in the treatment of coronary heart disease with left ventricular dysfunction

作　　者：丁志威 谢周良 权晓强 DING Zhiwei;XIE Zhouliang;QUAN Xiaoqiang(Department of Cardiology,Fuwai Huazhong Cardiovascular Hospital,Zhengzhou 450000,China)

机构地区：[1]河南阜外华中心血管病医院心外三科室,450000

出　　处：《心肺血管病杂志》2020年第11期1355-1358,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析心肺转流不停跳冠状动脉旁路移植术(OBCAB)治疗冠心病合并左心室功能不全的疗效,以为临床提供治疗依据。方法:回顾性分析2018年6月至2019年6月,我院收治的60例冠心病合并左心室功能不全患者的诊疗情况。其中30例给予心肺转流OBCAB治疗,30例采用非体外循环冠状动脉旁路移植术治疗(OPCAB)。分析比较两组患者术后30 d病死率、主动脉内球囊反搏(IABP)辅助率、再次手术止血率、机械通气时间、ICU停留时间、术后24 h引流量、LVEF改善程度、并发症的差异。结果:两组患者的术后30 d病死率、IABP辅助率、再次手术止血率相比,差异无统计学意义(P>0.05)。两组患者的机械通气时间、ICU停留时间、LVEF相比,差异无统计学意义(P>0.05);而OP-CAB组的术后24 h引流量、移置血管数、LVEF改善程度[(520.12±148.20)mL、(2.86±0.67)支、(3.67±0.94)%]均明显低于OBCAB组[(715.81±187.23)mL、(3.79±0.82)支、(4.85±0.34)%],差异有统计学意义(P<0.05)。两组患者低心排血量综合征、肺炎、肾功能不全、纵隔感染发生率相比,差异无统计学意义(P>0.05)。结论:与OPCAB相比,OBCAB可取得更充分的完全再血管化,对患者术后左心室功能具有较强的改善能力,可选择性应用于冠心病合并左心室功能不全患者的临床治疗中。但是,最终术式的选择需根据患者的临床表现、超声心动图、冠状动脉造影及术中探查结果进行综合评定。Objective:To analyze the therapeutic effect of on-pump beating heart coronary artery bypass grafting(OBCAB)in the treatment of coronary heart disease with left ventricular dysfunction,so as to provide the basis for clinical treatment.Methods:The diagnosis and treatment of 60 patients with coronary heart disease and left ventricular dysfunction admitted to our hospital from June 2018 to June 2019 were analyzed ret-rospectively.They were divided into OBCAB group(30 cases)and off-pump beating heart coronary artery by-pass grafting(OPCAB)group(30 cases).30 day mortality,IABP assist rate,hemostasis rate of reoperation,mechanical ventilation time,ICU stay time,24-hour drainage after operation,improvement of ejection fraction,complications of two groups were compared.Results:There was no significant difference in 30 day mortality,IABP auxiliary rate and hemostasis rate of reoperation between the two groups(P>0.05).There was no significant difference in mechanical ventilation time,ICU stay time and ejection fraction between the two groups(P>0.05).The improvement of the drainage volume,the number of grafts and the ejection fraction of the OPCAB group[(520.12±148.20)mL,(2.86±0.67)branches,(3.67±0.94)%]were significantly lower than the OBCAB group[(715.81±187.23)mL,(3.79±0.82)branches,(4.85±0.34)%],the difference was statistically significant(P<0.05).There was no significant difference in the incidence of low cardiac output syndrome,pneumonia,renal insufficiency,mediastinal infection between two groups(P>0.05).Conclusions:Compared with OPCAB,OBCAB can achieve more complete revascularization,which has a strong ability to improve the postoperative left ventricular function,and can be selectively applied to the clinical treatment of patients with coronary heart disease and left ventricular dysfunction.However,the final choice of operation mode needs to be comprehensively evaluated according to the clinical manifestations of patients,echocardiography,coronary angiography and intraoperative exploration result.

关 键 词：心肺流转术 冠状动脉旁路移置术 冠心病 左心室 疗效 

分 类 号：R54[医药卫生—心血管疾病]