改良钻石方案治疗心脏外科手术围手术期低射血分数型心衰患者  

Experience in the treatment of patients with low ejection fraction during perioperative period of open heart surgery with"Modified Diamond Protocol"

作　　者：许万紫 程永庆 金珉 徐莉 Xu Wanzi;Cheng Yongqing;Jin Min;Xu Li(Department of Cardiac Surgery,Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Clinical Trial Institution,the Affiliated Hospital of Yangzhou University,Yangzhou 225012,China)

机构地区：[1]南京鼓楼医院心脏外科,南京210008 [2]扬州大学附属医院临床试验机构办,扬州225012

出　　处：《中华胸心血管外科杂志》2025年第2期98-104,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：江苏十三五科教强卫工程医学重点学科(ZDXKA2016019)。

摘　　要：目的:探讨改良钻石方案治疗心脏外科手术围手术期低射血分数型心力衰竭(心衰)患者的临床效果和近期随访结果。方法:回顾性收集2022年8月至2024年1月期间在南京鼓楼医院心脏外科接受开放性心脏手术治疗的62例患者的临床资料,其中男48例,女14例;年龄20~86岁,平均(63.3±11.5)岁;术前均确诊为低射血分数型心衰,左心室射血分数(LVEF)≤0.35。根据术后心衰药物矫治方案进行分组,接受改良钻石方案治疗的21例患者纳入改良组,接受普通治疗方案的41例患者纳入对照组。比较两组患者的性别、年龄、术前合并慢性病特征等基线资料。观察并比较两组患者术前、术后、出院末次随访时的左心室舒张末期内径(LVDd)、肺动脉压力(PH)、LVEF、术后心衰改善、病死率及再住院率情况。结果:全组手术顺利,无围手术期死亡。两组患者术前基线资料比较差异无统计学意义(P>0.05)。出院前末次复查心功能,患者PH降低,LVDd缩小,LVEF增加,组内比较均较术前改善,差异有统计学意义(P<0.05);组间比较改良组PH降低[-17 mmHg对-12 mmHg(1 mmHg=0.133 kPa)],LVDd减少(-0.59 mm对-0.57 mm),LVEF增加(0.08对0.03),改良组总体心功能改善占优,但差异无统计学差异(P>0.05)。末次随访复查心功能,两组患者PH降低,LVDd缩小,LVEF增加,组内比较均较术前改善,差异有统计学意义(P<0.05);组间比较改良组PH下降(-17 mmHg对-12 mmHg),LVDd减少(-0.58 mm对-0.57 mm),LVEF增加(0.06对0.07),两组总体心功能改善趋同,差异无统计学意义(P值均>0.05)。术后随访3~12个月,1年内总病死率12.9%(8/62)。改良组再住院率明显低于对照组(9.5%对36.6%,P=0.02),且病死率相对较低(4.8%对19.5%,P=0.11)。结论:改良钻石方案是提升低射血分数型心脏手术患者术后心功能的有效方式,有助于术后早期恢复,再住院率降低,但长期病死率趋势仍有待观察。Objective To explore the clinical outcomes and recent follow-up results of the Modified Diamond Protocol in patients with low ejection fraction heart failure(HF)during the perioperative period of cardiac surgery.Methods Retrospectively collected clinical data of 62 patients who underwent open heart surgery in the cardiac surgery department of Nanjing Drum Tower Hospital from August 2022 to January 2024,including 48 males and 14 females with mean age of(63.3±11.5)years old.All patients were diagnosed with low ejection fraction heart failure preoperatively,with left ventricular ejection fraction(LVEF)≤0.35.Based on the indications of postoperative heart failure medication,21 patients who received the Modified Diamond Protocol treatment were included in the Modified group,and 41 patients who received the standard treatment plan were included in the Control group.The baseline clinical characteristics and data of the two groups were compared.The left ventricular end-diastolic diameter(LVDd),pulmonary artery pressure(PH),LVEF,postoperative heart failure improvement,mortality,and readmission rates at preoperative,postoperative,and final discharge follow-up times of the two groups were analyzed.Results There was no statistical difference in baseline data between the control group and the modified diamond regimen group(P>0.05).There were no perioperative deaths in either group of patients.Compared to preoperative levels,there were significant decrease in PH,a significant reduction in LVDd,and significant increase in LVEF within each group(P<0.05).Compared to control group,the Modified group demonstrated a greater reduction in PH(-17 mmHg vs.-12 mmHg,1 mmHg=0.133 kPa),a greater reduction in LVDd(-0.59 mm vs.-0.57 mm),and a greater increase in LVEF(0.08 vs.0.03),indicating an overall better improvement in cardiac function in the Modified group.However,there were no statistically significant differences between two groups(P>0.05).All patients were followed up for 3-12 months.The overall mortality rate within 1 year was 12

关 键 词：射血分数下降型心力衰竭 维利西呱 钻石方案 心脏手术 

分 类 号：R654.2[医药卫生—外科学] R541.6[医药卫生—临床医学]