术前左室射血分数及短缩分数对冠状动脉旁路术后恶性心律失常的预测价值

Clinical Evaluation of EF and FS as a Predictor of Preoperative Ventricular Arrhythmia

为了评价冠状动脉旁路术 (CABG)术前左室射血分数 (LVEF)及左室短缩分数 (LVFS)对术后室性心律失常 (VA)预测的准确性 ,采用术前及术后 2周心脏彩超EF、FS值 (面积长轴法 )、心室晚电位 (VLP)、心肌酶、持续心电监测的方法 ,对我院 1 5 0例行CABG术的患者进行分析。结果 :1 )术前心肌梗死 (MI)、室壁瘤、VA及VLP阳性患者EF、FS值明显减低 ;2 )术前左心功能不全 (LVD)患者术后EF、FS值明显改善 ;3 )术前LVD、VA、VLP阳性及室壁瘤患者术后VA发生率明显高于其他患者。提示 :1 )面积长轴法EF、FS值是反映左心功能的敏感指标 ;2 )术前LVD患者术后短期左心功能明显好转 ,获益最大 ;3 )非LVD患者术后因心肌顿抑导致近期心功能暂时下降 ;4 )EF≤ 4 0 %和(或 )FS≤ 2 4 %是预测术后VA的独立指标 ,FS较EF更能准确地反映心脏收缩功能 ;5 )LVD、VLP、室壁瘤等综合指标分析有助于提高对术后VA预期的敏感性。

In order to evaluate the accuracy of left ventricular ejection fraction (EF) and fractional shortening (FS) for predicting malignant ventricular arrhythmia (VA) after coronary artery bypass graft (CABG). One hundred and fifty consecutive patients were selected for an isolated CABG procedure, EF and FS, left ventricular potential (LVP), myocardial enzymes and 24 h Holter were measured in special perioperative period. 1) Patients with previous myocardial infarction (MI), aneurysm, positive LVP had obviously lower value of EF and FS before CABG than those without them. 2) In patients with LVD, significant improvements were found in EF and FS indexes after CABG. 3) The incidence of postoperative VA is higher in these patients with LVD, VA, VLP+ and aneurysm than the others. The results showed that: 1) EF and FS were sensitive indexes in reflecting left ventricular function. 2) CABG and aneurysmectomy not only improved myocardial blood supply, but also increased the heart out put, and brought the best benefits to those patients with LVD. 3) For the reason of myocardial depression, the cardiac function of patients without LVD decreased in short term follow up (14±1) d. 4) EF≤40% and/or EF≤24% were independent predictors for the prevision of malignant VA, the value of FS accurately reflected left ventricular function. 5) Integrate with other indexes, such as LVD, VLP and aneurysm, would improve the sensitivity, specialty and accuracy for predicting malignant VA after CABG.