非体外循环冠脉搭桥术治疗心肌缺血的左室舒张功能研究

Assessment of left ventricular diastolic function after off- pump coronary artery bypass with echocardiography

目的评价非体外循环冠脉搭桥术(OPCAB)对左室重构和舒张功能的影响。方法应用彩色多普勒超声技术对冠心病患者的肺静脉(PVF)和二尖瓣(MVF)血流及左室射血分数(LVEF)等心功能指标进行分析,87例行OPCAB的冠心病患者,根据术前LVEF≤40%和>40%分为A(38例),B(49例)两组,应用经胸(TTE)和经食管(TEE)超声心动图对OPCAB前及术后3月内的PVF、MVF和LVEF等指标进行评价。结果PVF、MVF各项参数术后测值与正常对照组(P<0.001)和术前(P<0.05)比较差异有统计学意义,术后峰值流速均示升高(P<0.05),PVa负值减低,PVs/PVd提高,MVe/MVa减低(P<0.05～0.01)。TTE对PVF血流参数的测值低于TEE(P<0.05)。LVEF(56.1±12.1)%较术前(48.2±13.6)%显著增加(P<0.01),EDV(P<0.01)、ESV(P<0.001)测值较术前显著降低。A、B两组术后LVEF均较术前明显提高(P<0.01),组间比较显示B组术后各项测值高于A组(P<0.05～0.01)。结论OPCAB能够显著改善左室整体功能,并明显提高心脏的舒张状态。伴有明显左心功能不全的患者,术后心功能仍能得到显著改善。多普勒超声为临床提供了一种可靠的定量评价血管重建术的方法。

Objective To investigate the impact of left ventricular （LV） diastolic function by measure the flow velocities of pulmonary vein （PVF） and mitral valve （MVF） before and after Off-pump Coronary Artery Bypass （OPCAB ） Methods PVF, MVF and left ventricular ejection fraction （LVEF） were measured in 87 patients with coronary heart disease （CHD） by echocardiography within two weeks pre-OPCAB. The patients were divided into two groups according to LVEF ≤40%（group A n=38cases） or 〉40% （group B n=49cases）. The values were compared with the results repeated after three months post revascularization. Results Significantly improvement were observed in PVF and MVF after OPCAB （P〈0.05,0.01 respectively）. The peak velocities of PVF and MVF had significantly improved （P〈 0.05,0.01 respectively）. Conclusion OPCAB can improve LV function, especially the diastolic function early after operation.