巨大左心室伴低射血分数的冠脉搭桥手术临床疗效分析

Effect of coronary artery bypass grafting on patients with enlarged left ventricular and reduced eject fraction

目的评估巨大左心室合并左室射血分数低下（EF〈35％）的冠状动脉旁路移植手术的临床效果。方法从2014年1月至2017年5月，有22例左心室显著扩大及EF低下的冠心病患者在我院接受冠状动脉旁路移植手术，超声均提示左心室舒张末直径超过6．5cm，EF〈35％，左心室动度弥漫性下降。采取非停跳冠状动脉旁路移植手术方式，手术中部分病例使用主动脉球囊反搏，搭桥材料选择左侧乳内动脉和下肢大隐静脉。术后复查心脏超声，同时记录围手术期临床资料和并发症情况，并对出院病例进行随访。随访时间为3个月。结果22例病例中死亡1例，死亡原因为顽固性低心排合并多脏器功能不全。住院期间发生肺部感染2例，急性肾脏功能不全2例（未经透析治疗恢复），顽固性室性心律失常3例（其中1例安置心内除颤器，另2例151服可达龙后一直随访）。左心室射血分数术前为0．30±0．04，手术后3个月测量为0．35±0．05，左心室舒张末内径术前为（67．1±4．2）mm，术后降至（61．3±3.3）Inm。结论巨大左心室合并低射血分数的冠脉搭桥手术有较高的安全性，再血管化可以改善心脏功能和和心脏容积。

Objective To investigate the effect of coronary artery bypass grafting（CABG） on patients with enlarged left ventricle and reduced eject fraction. Methods From Jan 2014 to May 2017, 22 consecutive patients with enlarged left ventricle and reduced low eject fraction have received the coronary artery bypass grafting in our hospital. The involving criteria included： the Dimension of left ventricle larger than 65 mm, eject fraction lower than 35% and the defused of the left ventricular mobility diffused reduced. The cases with left ventricular aneurysm were excluded. All the CABG had used the off-pump technique and part of them was assisted by the [ABP. All the cases were using the left mammary artery and the saphenous veins as the grafts. The cardiac ECHO was used to assess the recovery of the left ventricle. And the perioperative complications and the follow up results were recorded. The follow-up time was 3-24 months. Results I case died in the hospital for the consistent low output syndrome and multiple organ failure. 2 cases had complicated with pneumonia; 2 cases suffered with acute renal failure and had recovered without dialysis. 3 cases had consistent ventricular tachycardia in the ICU, who were treated with Amiodarone. One of them had to be implanted the CRTD and another two had been medically stabilized. Ultrasound cardiography in the follow-up period showed that there was a decreased left ventricular end-diastolic dimension [ （67.1±4.2）mm vs. （61.3±3.3）mm, P〈0.05 ] and an improved left ventricular ejection fraction （0.30±0.04 vs. 0.35±0.05, P〈0.05）. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with enlarged left ventricle and reduced eject fraction .