实时三维超声心动图评价冠脉搭桥术前后左室收缩功能的应用价值

Assessment of left ventricular systolic function in patients after coronary artery bypass grafting using real-time three-dimensional echocardiography

目的应用实时三维超声心动图技术(RT-3DE)评价非体外循环冠状动脉搭桥术(OPCABG)前后左室整体及局部收缩功能的变化。方法选择行OPCABG的冠心病患者30例作为手术组,均将左内乳动脉与左前降支(LAD)行端侧吻合。另选正常对照20例。应用RT-3DE检测手术组术前、术后及对照组左室整体舒张末容积(LVEDV)、收缩末容积(LVESV)、射血分数(LVEF)及LAD供血节段局部的舒张末容积(rEDV)、收缩末容积(rESV)、射血分数(rEF)。结果手术组术后LV-EDV、LVESV较术前减小(P<0.05),LVEF较术前增大(P<0.05),LAD供血节段rEDV、rESV较术前减小,rEF较术前增大;手术组术前及术后LVEDV、LVESV较对照组增大(P<0.05),LVEF较对照组减小(P<0.05),LAD供血节段rEDV、rESV较对照组增大,rEF较对照组减小。结论RT-3DE可以定量评价冠心病患者OPCABG前后左室整体及局部收缩功能的改变,对评价其治疗效果及预后具有重要的临床价值。

Objective To assess the changes of global and regional left ventricular（LV）systolic function in patients with coronary artery disease（CAD）before and after off-pump coronary artery bypass grafting（OPCABG）using real-time three-dimensional echocardiography（RT-3DE）. Methods RT-3DE was performed in 30 patients with CAD before and after OPCABG and 20 healthy controls.All the patients underwent end-to-side blood anastomosis of left internal mammary artery and the left anterior descending coronary artery（LAD）.Global LV end-diastolic volume（LVEDV）,end-systolic volume（LVESV）,ejection fraction（LVEF）and the regional end-diastolic volume（rEDV）,end-systolic volume（rESV）,ejection fraction（rEF）in LAD segments were measured and analyzed. Results Gompared with that before OPCABG,LVEDV and LVESV decreased after OPCABG（P〈0.05）,while LVEF increased（P〈0.05）.Compared with that before OPCABG,rEDV and rESV decreased in LAD segments after OPCABG,while rEF increased in LAD segments.LVEDV and LVESV were bigger in CAD patients than that in controls before and after OPCABG（P〈0.05）,while LVEF was smaller（P〈0.05）.The rEDV and rESV in most LAD segments were bigger in CAD patients than that in controls before and after OPCABG,while rEF was smaller. Conclusion RT-3DE can accurately assess the changes of global and regional LV systolic function before and after OPCABG in patients with CAD,and evaluate the prognosis.