全动脉化冠状动脉旁路移植术在左心室功能低下患者中的应用价值  

Application value of total arterial revascularization combined with coronary artery bypass grafting in patients with left ventricular dysfunction

作　　者：严哲 张小涛 李晓恒 Yan Zhe;Zhang Xiaotao;Li Xiaoheng(Department of Cardiac Surgery,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China)

机构地区：[1]郑州大学附属洛阳中心医院心外科,洛阳471000

出　　处：《中国实用医刊》2022年第9期18-21,共4页Chinese Journal of Practical Medicine

摘　　要：目的分析全动脉化(TAR)冠状动脉旁路移植术(CABG)在左心室功能低下[左室射血分数(LVEF)≤35%]患者中的应用价值。方法回顾性收集2018年1月至2021年3月于郑州大学附属洛阳中心医院行CABG术的72例合并左心室功能低下患者的临床资料,根据手术方法将患者分为常规组与TAR组,每组36例。常规组采用左乳内动脉+大隐静脉CABG术,TAR组采用TAR CABG术[取双侧乳内动脉、左侧或(和)右侧桡动脉]。比较两组围术期情况、术后远期血管通畅率、心肌功能[24 h肌酸激酶同工酶(24 h CK-MB)、24 h心肌肌钙蛋白T(24 h cTnT)]、心脏超声指标[左心室舒张末期内径(LVEDD)、LVEF]、并发症发生率及不良预后发生率。结果与常规组比较,TAR组手术时间长、术后呼吸机辅助时间短(P<0.05)。术后6个月,TAR组血管通畅率(91.67%,33/36)高于常规组(72.22%,26/36),P<0.05。TAR组24 h CK-MB、24 h cTnT水平均低于常规组(P均<0.05);术后6个月,TAR组LVEDD低于常规组,LVEF高于常规组(P<0.05)。两组并发症发生率比较差异未见统计学意义(P>0.05)。TAR组不良预后发生率(8.33%,3/36)低于常规组(27.78%,10/36),P<0.05。结论对于左心室功能低下患者,行TAR CABG术治疗手术时间相对较长,但可缩短术后呼吸机辅助时间,可改善心功能和心肌功能,并可预防并发症,降低不良预后发生率。Objective To analyze the value of total arterial revascularization(TAR)combined with coronary artery bypass grafting(CABG)in patients with low left ventricular dysfunction,that is,with left ventricular ejection fraction(LVEF)≤35%.Methods The clinical data of 72 patients with left ventricular dysfunction after CABG in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2018 to March 2021 were collected retrospectively.According to the operation methods,patients were divided into routine group and TAR group,with 36 cases in each group.Patients in the routine group were treated by left internal mammary artery combined with great saphenous vein CABG;while patients in the TAR group were treated by TAR combined with CABG(via bilateral internal mammary artery,left or/and right radial artery).The perioperative conditions,long-term vascular patency rate,myocardial function assessed by 24 h creatine kinase isoenzyme(24 h CK-MB)and 24 h cardiac troponin T(24 h cTnT),cardiac ultrasound indexes including left ventricular end-diastolic diameter(LVEDD)and LVEF,incidence of complications,and adverse prognosis were compared between the two groups.Results Compared with the routine group,the TAR group had longer operation time and shorter postoperative ventilator assistance time(P<0.05).The vascular patency rate of the TAR group(91.67%,33/36)was higher than that of the routine group(72.22%,26/36)6 months after operation(P<0.05).Compared with the routine group,the levels of 24 h CK-MB and 24 h cTnT in the TAR group were lower(all P<0.05);6 months after operation,the TAR group had lower LVEDD and higher LVEF,compared with the routine group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The incidence of poor prognosis in the TAR group(8.33%,3/36)was lower than that in the routine group(27.78%,10/36),P<0.05.Conclusions For patients with left ventricular dysfunction,TAR combined with CABG has a relatively long operation time,however,it can shorten posto

关 键 词：冠状动脉旁路移植术 左心室功能低下 全动脉化 血管通畅率 

分 类 号：R654.2[医药卫生—外科学]