冠状动脉旁路移植术治疗缺血性心功能不全患者的远期疗效

Long-term Results of Coronary Artery Bypass Grafting in the Treatment of Ischemic Cardiac Diseases with Heart Insufficiency

目的分析缺血性心功能不全患者接受冠状动脉旁路移植术(CABG)的远期生存率和心力衰竭免除率,以评价单纯CABG治疗缺血性心功能不全患者的远期疗效。方法 1999年1月至2005年12月阜外心血管病医院收治冠心病伴左心功能不全(左心室射血分数<40%)患者239例,其中男215例,女24例;年龄32～78岁,平均年龄59.1岁。术前有心肌梗死病史193例,有心绞痛31例;心功能分级(NYHA)Ⅰ级26例,Ⅱ级106例,Ⅲ级73例,Ⅳ级34例。冠状动脉造影显示:单支血管病变10例(4.2%),2支病变35例(14.6%),3支病变194例(81.2%);术前超声心动图提示:左心室射血分数35.7%±4.6%。所有患者均接受CABG,体外循环CABG153例(64.0%),非体外循环CABG86例(35.9%);择期手术237例,急诊手术2例。同期未行心瓣膜成形或置换术、室壁瘤切除和折叠术等其他手术。结果每例移植旁路血管1～6支(3.4±1.1支)。院内死亡5例(2.09%),其中因低心排血量、循环衰竭死亡2例,发生恶性心律失常死亡1例,肾功能衰竭死亡1例,昏迷并发多器官功能衰竭死亡1例。随访216例(92.3%),随访时间5.12±1.79年;失访18例(7.7%)。随访期间死亡29例,其中心源性死亡24例,心源性死亡率1年为2.8%,5年为9.4%;发生心力衰竭40例,1年心力衰竭免除率为93.7%,5年免除率为81.8%;1年生存率为97.2%,5年生存率为89.3%。结论 CABG治疗缺血性心功能不全患者的远期疗效满意。

Objective To evaluate the long-term results of coronary artery bypass grafting （CABG） in treating cardiac diseases with heart insufficiency by analyzing the long-term survival rate and heart failure exemption rate of the patients.Methods A total of 239 patients who had coronary heart disease with left heart dysfunction （LVEF40%） were enrolled in our study.Among the patients,there were 215 males and 24 females aged from 32 to 78 years old with an average age of 59.1.Before operation,193 patients had a past history of myocardial infarction and 31 had angina.According to the New York heart function assessment （NYHA）,26 patients were categorized as class Ⅰ,106 as class Ⅱ,73 as class Ⅲ and 34 as class Ⅳ.Coronary angiography showed 10 cases （4.2%） of single vessel disease,35 cases （14.6%） of double vessel disease and 194 cases （81.2%） of triple vessel disease.The result of preoperative ultrasound cardiogram showed that LVEF was 35.7%±4.6%.All patients received CABG,including 153 （64.0%） on-pump surgeries and 86 （35.9%） off-pump surgeries.Selective operation was done on 237 patients and there were 2 emergency cases.Valve repair or replacement,ventricular aneurysmectomy or aneurysm plication were not carried out during the operation.Results There were 1 to 6 （3.4±1.1） bypass grafting vessels in each case.Five （2.09%） patients died during the hospital stay,among which 2 died of low cardiac output and circulation failure,1 died of malignant arrhythmia,1 died of renal failure,and 1 died of coma with multi-organ failure.The follow-up period was 5.12±1.79 years.During the follow-up,18 patients （7.7%） were lost and 29 patients died.Among them,there were 24 cardiac deaths and the cardiac death rate at the first year and the fifth year was 2.8% and 9.4% respectively.There were 40 cases of heart failure during the follow-up period.The exemption rate of heart failure was 93.7% and 81.8% at the first year and the fifth year respectively.The survival rate was 97.2% at the first year and 89.3% at the fifth year.Conclusion The long-term result of CABG in treating patients with ischemic heart insufficiency is satisfying.