冠状动脉粥样硬化性心脏病伴左心功能不全高危患者的外科治疗

Surgical treatment in high risk patients with coronary artery disease and left ventricular dysfunction

目的总结分析冠状动脉粥样硬化性心脏病(冠心病)伴左心功能不全高危患者行外科治疗的疗效。方法回顾性分析29例高危冠心病伴左心功能不全患者(年龄>70岁)外科治疗的临床资料,着重分析手术方法和疗效。结果围手术期死亡5例(17.2%,5/29),均死于严重低心排血量综合征。超声心动图复查示术后左心室舒张期末内径与术前比较明显减小,差异有统计学意义[(54.71±4.91)mm vs.(58.33±3.46)mm,t=3.2442,P<0.05];左心室射血分数较术前明显提高(45.36%±10.27%vs.32.86%±4.10%,t=6.0873,P<0.05)。结论对于高龄伴左心功能不全冠心病患者行外科治疗,其手术时机和手术方式的合理选择,围手术期的积极治疗能明显提高术后生存率。

Objectives To analyze and summarize surgical treatment in high risk patients with coronary artery disease comparing with left ventricular dysfunction.Methods We retrospectively analyzed the clinical data of 29 high risk patients（age70 years） with coronary artery disease and left ventricular dysfunction,focucing on surgical treatment method and curative effect.Results There were 5 perioperative cases died of severe low cardiac output syndrome.Echocardiography showed that postoperative left ventricular end diastolic diameter（LVEDD） reduced significantly compared with that before operation[（54.71± 4.91）mm vs.（58.33 ± 3.46）mm,t=3.2442,P 0.05];left ventricular ejection fraction increased after operation and the difference had statistic significance（45.36% ± 10.27% vs.32.86% ± 4.1%,t = 6.0873,P 0.05）.Conclusions In treatment of coronary artery disease of aged patients with left heart failure,reasonable choice of timing of surgery and aggressive treatment of preoperative can significantly improve survival rates.