非体外循环下冠状动脉旁路移植术对冠心病老年患者右心室功能的影响分析  

Analysis of the effect of off-pump coronary artery bypass grafting on right ventricular function in elderly patients with coronary heart disease

作　　者：马刚[1] 赵学凯[1] 郝斌 刘冰 翟奇轩 王盛 李梓 成坤 MA Gang;ZHAO Xuekai;HAO Bin;LIU Bing;ZHAI Qixuan;WANG Sheng;LI Zi;CHENG Kun(Department of Cardiovascular Surgery,Zibo Central Hospital,Zibo Shandong 255036,China)

机构地区：[1]淄博市中心医院心脏大血管外科,山东淄博255036

出　　处：《中国急救复苏与灾害医学杂志》2023年第9期1131-1134,1214,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：淄博市重点研发计划(编号:2020ZC010130)。

摘　　要：目的探究非体外循环下冠状动脉旁路移植术(OPCAB)对冠心病老年患者右心室收缩及舒张功能的影响。方法以2021年4月—2022年4月在淄博市中心医院行OPCAB手术治疗的老年冠心病患者44例为研究对象进行回顾性分析。采用经胸超声心动图评估患者右心室功能,比较OPCAB术后7 d较术前右心室收缩及舒张功能参数的变化情况。结果与术前比较,OPCAB术后7 d冠心病患者三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期速度(s′)、等容收缩时间(IVCT)、等容舒张时间(IVRT)、射血时间(ET)降低(P<0.05)。OPCAB术后7 d冠心病患者较术前三尖瓣E峰减速时间(DT)、三尖瓣环侧壁和间隔运动速度(e′)降低(P<0.05),舒张早期血流峰值速度(E)、舒张晚期血流峰值速度(A)及E/e′比值升高(P<0.05)。根据超声心动图左心室射血分数结果,12例(27.3%)患者出现左心室收缩功能障碍。按左心室收缩功能分层后,OPCAB术后7 d冠心病患者TAPSE值、s′值、DT值较术前降低(P<0.05),E/e′比值较术前升高(P<0.05)。结论OPCAB术后7 d冠心病老年患者较术前表现出纵向收缩功能降低,舒张功能恶化。此外,按左心室收缩功能分层后,OPCAB术后7 d右心室功能变化无显著差异。Objective To study the effect of off-pump coronary artery bypass grafting(OPCAB)on right ventricular systolic and diastolic function in elderly patients with coronary heart disease.Methods A retrospective analysis was performed on 44 elderly patients with coronary heart disease who underwent OPCAB surgery in Zibo Central Hospital from April 2021 to April 2022.Transthoracic echocardiography was used to assess the right ventricular function of the patients,and the changes of right ventricular systolic and diastolic function parameters 7 days after OPCAB were compared with those before operation.Results Tricuspid annular plane systolic excursion(TAPSE),tricuspid annular systolic velocity(s′),isovolumic contraction time(IVCT),isovolumic relaxation time(IVRT),and ejection time(ET)were decreased in patients with coronary artery disease at 7 days postoperatively after OPCAB compared with preoperatively(P<0.05).Compared with the preoperative period,tricuspid E peak deceleration time(DT),tricuspid annular lateral wall and septal motion velocities(e′)were decreased(P<0.05),and peak early diastolic flow velocities(E),peak late diastolic flow velocities(A),and E/e′ratios were elevated(P<0.05)in patients with coronary artery disease at 7 days postoperatively after OPCAB.According to the echocardiographic left ventricular ejection fraction results,left ventricular systolic dysfunction was present in 12 cases(27.3%).After stratification by LV systolic function,TAPSE,s′,and DT values were lower(P<0.05)and E/e′values were higher(P<0.05)in coronary artery disease patients 7 days after OPCAB compared with the preoperative period.Conclusion Elderly patients with coronary artery disease 7 days after OPCAB demonstrated reduced longitudinal systolic function and worsened diastolic function compared with the preoperative period.In addition,after stratification by left ventricular systolic function,there was no significant difference in the change in right ventricular function 7 days after OPCAB.

关 键 词：非体外循环下冠状动脉旁路移植术 冠心病 老年患者 右心室功能 

分 类 号：R541.4[医药卫生—心血管疾病]