重度左心室功能低下患者心脏不停搏冠状动脉旁路移植术探讨  

Feasibility of Off Pump Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction

作　　者：师闯 曹向戎[2] 金琪琳 王坡 孟祥宽 SHI Chuang;CAO Xiangrong;JIN Qilin;WANG Po;MENG Xiangkuan(Daxing Teaching Hospital of Capital Medical University,Beijing 102699,China;Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学大兴教学医院,北京102699 [2]首都医科大学附属安贞医院,北京100029

出　　处：《岭南心血管病杂志》2024年第4期364-367,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨重度左心室功能低下患者不停搏冠状动脉旁路移植术(off-pump coronary artery bypass grafting,Off-pump CABG)的可行性。方法筛选首都医科大学大兴教学医院2017年5月至2022年5月,无法介入干预或介入干预失败同时不伴有其他需外科干预的冠状动脉粥样硬化心脏病(冠心病)变患者32例,其中男28例、女4例,左心室射血分数(left ventricular ejection fraction,LVEF)<30%,年龄为(62.1±7.4)岁。术前均行心肌核素扫描,术前、术中同期预置主动脉球囊反搏。所有患者均采用体外循环湿备下非体外循环Off-pump CABG术。结果无患者死亡,32例患者心绞痛症状消失,生活质量明显改善。超声心动图3个不同时期(术前、术后10~14 d、术后1年)LVEF、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)比较,差异有统计学意义(P<0.05)。结论充分术前准备的重度左心室功能低下患者采用Off-pump CABG术安全、有效。Objectives To explore the feasibility of off-pump coronary artery bypass grafting(Off pump CABG)in patients with severe left ventricular dysfunction.Methods From May 2017 to May 2022,32 patients with coronary heart disease who were unable to intervene or failed to intervene without other surgical interventions were selected from Daxing Teaching Hospital of Capital Medical University.Among them,28 were males and 4 were females,with a left ventricular ejection fraction(LVEF)less than 30%,aged(62.1±7.4)years.Myocardial nuclide scans were performed before surgery,and aortic balloon counterpulsation was pre-positioned both before and during surgery.All the patients underwent offpump CABG under extracorporeal circulation with wet preparation.Results No patient died.The symptoms of angina disappeared in all the 32 patients,and the life quality of who significantly improved.There were significant differences in LVEF,left ventricular end-systolic diameter(LVESD)and left ventricular end-diastolic diameter(LVEDD)among the three different stages of echocardiography(preoperative,postoperative 10-14 days,and postoperative 1 year),with statistical significance(P<0.05).Conclusions Off-pump CABG is a safe and effective procedure for patients with severe left ventricular dysfunction who have received sufficient preoperative preparation.

关 键 词：冠状动脉疾病 重度左心室功能低下 非体外循环心脏不停搏冠状动脉旁路移植术 术前准备 

分 类 号：R541.4[医药卫生—心血管疾病]