非体外循环冠状动脉搭桥术治疗低射血分数的左主干并三支病变患者疗效分析

The efficacy of off-pump coronary artery bypass grafting in the patients with low ejection fraction, left main coronary artery lesion and three-vessel lesion

目的探讨非体外循环冠状动脉搭桥术（OPCABG）治疗低左心室射血分数（LVEF）的左主干并三支病变患者的疗效。方法2010年1—12月我院收治低LVEF的左主干并三支病变的冠心病患者28例，均在全身麻醉下行OPCABG。分别于术前和术后3d进行血红蛋白（Hb）、血小板计数（PLT）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、尿素氮（BUN）、肌酐（Cr）的检测；术后3个月行心脏超声检查记录LVEF、左心室舒张末期内径（LVED）测定值，并与术前检查结果进行比较。结果1例因肺感染死于呼吸衰竭，剔除其数据。术前和术后3d27例患者Hb分别为（137．94±19．40）、（111．06±12．71）g/L，PLT分别为（210．43±48．26）、（148．40±52．20）×10^9／L，差异均有统计学意义（t值分别为5．239、4．869，P均〈0．01）；术前和术后3dALT分别为（27．66±11．51）、（29．02±16．40）U／L，AST分别为（26．55±10．12）、（27．75±8．14）U／L，BUN分别为（6．51±1．00）、（6．88±2．53）mmoFL，Cr分别为（96．35±15．25）、（95．11±24．38）μmol/L，差异均无统计学意义（t值分别为0．335、0．882、1．625、0．803，P均〉0．05）。术前及术后3个月LVEF分别为（36．23±3．41）％、（47．23±5．13）％，LVED分别为（62．23±5．93）、（58．08±5．02）mm，术后3个月LVEF较术前提高（t=6．904，P〈0．01），LVED明显缩小（t=2．790，P〈0．05）。结论OPCABG治疗低LVEF的左主干并三支病变患者早期效果满意，对患者全身重要器官影响有限。但远期疗效及预后还需进一步随访分析。

Objective To study the clinical efficacy of Off-Pump Coronary Artery Bypass Grafting （OPCABG） in the patients who have left main coronary artery stenosis and three-vessel lesion with low ejection fraction. Methods From January 2010 to December 2010,28 cases with low ejection fraction,left main coronary artery stenosis and three-vessel lesion and received OPCABG were analyzed retrospectively. All cases underwent OPCABG under general anesthesia. The Hb, PLT, ALT, AST, BUN and Cr count before and 3 days after operation were recorded. LVEF and LVED before and 3 months after operation were recorded. The data were compared. Results one case died of respiratory failure caused by pulmonary infection. The mortality rate was 3.75 %. The value of six parameters are： Hb （ [ 137. 94 ± 19.40 ], [ 111.06 ± 12. 71 ] g/L）, PLT （ [ 210. 43 ± 481 26 ] × 10^9/L, [ 148.4 ± 52. 20 ] ×10^9/L）, ALT （ [ 27. 66 ± 11.51 ] U/L, [ 29. 02 ± 16. 40 ] U/L）, AST （ [ 26. 55 ± 10. 12 ] U/L, [ 27.75 ± 8.14 ] U/L）, BUN （ [ 6. 51 ± 1.00 ] mmol/L, [ 6. 88 ± 2. 53 ] mmol/L）, Cr （ [ 96.35 ± 15.25 ] μmol/L, [ 95.11 ± 24.38 ] μmol/L）. Comparison of the values showed that Hgb and PLT were different significantly before and 3 days after operations. There was no significant difference in the levels of ALT, AST, BUN and Cr before and after the treatment. Three months later, LVEF and LVED were significantly different from that before treatment （ P 〈 0. 05 ）, with LVEF of（ [ 36. 23 ± 3.41 ] %, [ 47.23 ± 5.13 ] % ） and LVED of（ [62. 23 ±5.93 ] ram, [58.08 ± 5.02] mm）. Conclusion OPCABG produces a satisfactory outcome in the patients who have left main coronary artery stenosis and three-vessel lesion combined with low ejection fraction. There is limited impact of OPCABG on the other organs. The long-term effeet and prognosis are still need to be followed-up and analyzed.