巨大左心室而无室壁瘤冠心病患者行冠状动脉旁路移植术的疗效分析

Effect of Coronary Artery Bypass Grafting on Patients with Coronary Heart Disease and Giant Left Ventricular Dimension but without Aneurysm

目的分析冠状动脉旁路移植术（CABG）治疗巨大左心室而无室壁瘤冠心病患者的临床疗效,总结其治疗经验。方法回顾性分析2004年1月至2006年12月南京医科大学附属南京第一医院收治的51例巨大左心室而无室壁瘤冠心病患者的临床资料,其中男50例,女1例;年龄54~61岁（57.5±3.2岁）。所有患者均施行CABG,同期行主动脉瓣置换术7例,二尖瓣置换术16例,二尖瓣成形术17例,三尖瓣成形术7例。术后密切观察围术期并发症的发生,统计病死率,并随访37个月及以上。结果每例远端吻合口为2.0~4.0个（3.8±1.1个）。围术期死亡4例（7.8%）,术后死于恶性心律失常2例,急性肾功能不全1例,严重低心排血量综合征导致脑卒中1例;其余患者均康复出院。术后发生心房颤动5例,室性心律失常11例,均经相应的处理治愈。随访47例,随访率100%,随访时间37~49个月（43±11个月）。随访期间无死亡,复查超声心动图提示：左心室舒张期末内径较术前明显减小（59±2 mm vs.68±5 mm,t=7.320,P〈0.05）;左心室射血分数较术前明显增大（45%±17%vs.34%±15%,t=4.770,P〈0.05）。结论 CABG是治疗巨大左心室而无室壁瘤冠心病患者较好的外科治疗方法。

Objective To investigate the effect of coronary artery bypass grafting（CABG） on patients with coronary heart disease and giant left ventricular dimension but without aneurysm.Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm,including 50 males and 1 female,undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed.The patients were at the age of 54-61 years with an age of 57.5±3.2 years.All patients received CABG,combined with aortic valve replacement in 7,mitral valve replacement in 16,mitral valvoplasty in 17 and tricuspid valvoplasty in 7.After surgery,peri-operative complications and mortality were closely observed and follow-up for a period of 37 months was carried out.Results The number of distal anastomoses per patient was 2.0-4.0（3.8±1.1）.Four patients died peri-operatively（7.8%）,among whom 2 died from malignant ventricular fibrillation,1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome.All other patients were discharged from hospital with good recovery.After operation,5 patients had atrial fibrillation and 11 had ventricular fibrillation,but all of those patients survived after proper treatment.The follow-up period for 47 patients was 37-49 months（43±11months）,with a follow-up rate of 100%.No death occurred during the follow-up.Ultrasound cardiography in the follow-up period showed that there was a decreased left ventricular end-diastolic dimension（59±2 mm vs.68±5 mm;t=7.320,P0.05） and an improved left ventricular ejection fraction（45%±17% vs.34%±15%;t=4.770,P0.05） compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.