左心室重构与低射血分数冠状动脉旁路移植术患者围手术期风险及预后的相关性分析  

Correlation between perioperative risk and prognosis of left ventricular remodeling in patients with low ejection fraction undergoing coronary artery bypass grafting

作　　者：王坡 曹向戎[2] 王丕杉 金琪琳 孟祥宽 房磊 胡晓宇 WANG Po;CAO Xiangrong;WANG Pishan;JIN Qilin;Meng Xiangkuan;FANG Lei;HU Xiaoyu(Department of Cardiac Surgery,Beijing Daxing District People's Hospital,Beijing 102600,China)

机构地区：[1]首都医科大学大兴教学医院心脏中心心外科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科

出　　处：《心肺血管病杂志》2023年第1期49-52,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨左心室重构对低射血分数(LVEF<40%)冠状动脉旁路移植术(CABG)患者围手术期风险及近期生存率的影响。方法:收集首都医科大学大兴教学医院心脏中心心外科2020年1月至2021年12月入院,LVEF<40%,冠心病行CABG术患者76例,其中男52例,女24例,年龄(63±8)岁。住院期间行经胸超声心动图检查测定LVEF和左心室收缩末期容积指数(LVESVI),患者LVESVI(98±16)mL/m^(2),以LVESVI 100 mL/m^(2)为界值分为两组:轻度左心室重构组(44例)定义为LVESVI,重度左心室重构组(32例)定义为LVESVI≥100 mL/m^(2)。术后随访6个月,比较两组患者手术死亡率、围手术期并发症及近期生存率。结果:围手术期死亡率5.3%(4/76)。重度左心室重构组患者围手术期死亡率高于轻度左心室重构组(9.4%vs.2.3%,P=0.03),同时重度左心室重构组患者术后应用主动脉内球囊反搏(IABP)比例较高(56.3%vs.29.5%,P<0.01),术后心房颤动发生率较高(28.1%vs.9.1%,P=0.03)。术后随访结果显示,轻度左心室重构组患者与重度左心室重构组患者相比,1、3及6个月无不良心血管事件生存率差异无统计学意义(100%vs.100%,97.7%vs.93.8%,95.5%vs.87.5%,P=0.23)。结论:左心室重构增加患者CABG围手术期并发症及死亡率,但对患者近期生存率无明显影响。Objective:To investigate the effect of left ventricular remodeling on perioperative risk and short-term survival in patients undergoing coronary artery bypass grafting(CABG)with low ejection fraction(LVEF<40%).Methods:From January 2020 to December 2021,76 patients[52 males and 24 females,the average age was(63±8)years old]with LVEF<40%who underwent coronary artery bypass grafting for coronary heart disease were enrolled.LVEF and left ventricular end-systolic volume index(LVESVI)were measured by transthoracic echocardiography during hospitalization.The LVESVI was(98±16)mL/m^(2).According to the value of LVESVI was 100 mL/m^(2),the patients were divided into two groups:LVESVI<100 mL/m^(2)was defined as mild LV remodeling group(n=44),and LVESVI≥100 mL/m^(2)was defined as severe LV remodeling group(n=32).The operative mortality,perioperative complications and short-term survival rate were compared between the two groups after 6 months follow-up.Results:The perioperative mortality rate was 5.3%(4/76).The perioperative mortality of patients with severe left ventricular remodeling was higher than that of patients with mild left ventricular remodeling(9.4%vs.2.3%,P=0.03).Meanwhile,the rate of intraaortic balloon pump(IABP)was higher in patients with severe left ventricular remodeling(56.3%vs.29.5%,P<0.01),and the incidence of postoperative atrial fibrillation was higher in patients with severe left ventricular remodeling(28.1%vs.9.1,P=0.03).Postoperative follow-up results showed that there was no significant difference in major adverse cardiac event(MACE)-free survival rate at 1 month,3 months and 6 months between two groups(100%vs.100%,97.7%vs.93.8%,95.5%vs.87.5%,P=0.23).Conclusions:Left ventricular remodeling increases perioperative complications and mortality in CABG patients,but has no significant effect on short-term survival.

关 键 词：冠状动脉旁路移植术 左心室重构 低射血分数 

分 类 号：R54[医药卫生—心血管疾病]