左室功能低下患者冠状动脉旁路移植术后心脏辅助装置应用情况及中远期疗效

Medium-and long-term outcomes of cardiac assist devices after coronary artery bypass grafting in left ventricular dysfunction patients

目的评估左室功能低下患者行冠状动脉旁路移植术术后心脏辅助装置的应用情况及中远期疗效。方法2012年1月至2018年5月,郑州大学第一附属医院心血管外科冠状动脉旁路移植术的患者中,筛选出127例围手术期左室射血分数(LVEF)≤40%的患者(左室功能低下组),男101例,年龄(59.2±10.1)岁,同期LVEF>55%的患者(2454例)为对照组,男1756例,年龄(58.4±9.5)岁。比较两组应用心脏辅助装置[主动脉内球囊反搏(IABP)及体外膜肺氧合(ECMO)]的临床数据。对所有患者进行门诊随访,对比两组随访结果。结果与对照组相比,左室功能低下组IABP(10.2%比0.8%)、ECMO(6.3%比0.3%)使用率更高,ICU停留时间更长[(50±12)h比(33±10)h],围手术期死亡率更高(4.7%比0.7%),术后住院时间更长[(15±3)d比(11±4)d],差异均有统计学意义(均P<0.05)。左室功能低下组LVEF术后3个月(48±8)%,术后6个月(51±9)%,术后1年(55±9)%,此后趋于稳定。结论左室功能低下患者行冠状动脉旁路移植术心脏辅助装置应用率高,良好的围手术期管理可挽救部分患者生命,且中远期随访效果良好,在临床上值得推广。

Objective To evaluate the medium-and long-term outcomes of cardiac assist devices after coronary artery bypass grafting(CABG)in patients with left ventricular dysfunction.Methods From January 2012 to May 2018,a total of 127 patients with low left ventricular ejection fraction(LVEF)value(≤40%)undergoing CABG in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University were selected.Meanwhile,another 2454 cases with LVEF>55%were also enrolled as controls.Clinical data of intra-aortic balloon pump(IABP)and extracorporeal membrane oxygenation(ECMO)application were compared and analyzed.All patients were followed up at the Outpatient Clinic at different time points(3 and 6 months after surgery,then every year).Results Compared to the control group,IABP usage(10.2%vs 0.8%),ECMO usage(6.3%vs 0.3%)and the mortality(4.7%vs 0.7%)were higher(all P<0.05)in the left ventricular dysfunction group.Additionally,Intensive Care Unit stay[(50±12)h vs(33±10)h]and the hospital stay after surgery[(15±3)d vs(11±4)d]was longer in the left ventricular dysfunction group(all P<0.05).In the left ventricular dysfunction group,LVEF at 3,6 month and 1 year was(48±8)%,(51±9)%,and(55±9)%,respectively,and then maintained stable.Conclusions Patients with left ventricular dysfunction who received coronary artery bypass grafting had a high rate of cardiac assist devicesuse,however,optimal perioperative management can save the lives of some patients,whose medium-and long-term outcome are good.Therefore,it is worthy of being recommended in clinical practice.