左室功能减低的冠心病患者冠状动脉旁路术的疗效评估

Coronary heart bypass grafting for patients with severely decreased left ventricular function

目的 :探讨左室功能减退患者冠状动脉旁路移植术 (CABG)的治疗结果。方法 :回顾性分析 2 0 0 0年12月～ 2 0 0 3年 4月因心肌梗死或长期慢性心肌缺血造成左室功能减退的 6 7例冠心病 (CHD)患者CABG的相关资料。结果 :6 7例中 ,6 1例联合应用左乳内动脉与前降支吻合 ,人均旁路移植 1～ 5 ( 3.4± 0 .3)支 ,无手术死亡。术后 6 7例随访 2～ 2 6个月 ,死亡 3例。左室射血分数由术前 ( 30 .9± 9.2 ) %提高至 ( 4 1.5± 6 .7) % ;左室舒张末内径由术前 ( 6 3.7± 7.9)mm降至 ( 5 6 .8± 3.4 )mm(P >0 .0 5 ) ;心绞痛发作明显减少 ,活动耐力均提高。结论 :左室功能减退的CHD患者 。

Objective:To summarize the surgical results of patients undergone coronary artery bypass grafting(CABG) with significantly decreased left ventricular ejection fraction(LVEF).Methods:Retrospectively analysed the peri operative data of 67 case suffering coronary heart disease(CHD) with significantly decreased LVEF because of myocardial infarction or chronic myocardial ischaemia receiving CABG from Dec.2000 to Apr. 2003.Results:Sixty one cases received left internal mammary artery(LIMA) anastomosed to left anterior artery(LAD). The average grafts for each case were 3.4 ± 0.3 (1～5). No operative death occurred. The post operative follow up was 2 to 26 months, there were three deaths. The post operative LVEF improved from ( 30.9 ± 9.2 )% to ( 41.5 ± 6.7 )% and compared with pre operative LVEF showing significantly statistical differences(P< 0.05 ). The postoperative LVEDD were 54.6 ～ 63.8 ( 56.8 ± 3.4 ) mm. The attack of angina pectoris significantly reduced. The exercises capacity increased. life quality improved markedly.Conclusion:The CHD patients with significantly decreased LVEF benefit from CABG. Its operative and early results are satisfactory. CABG significantly improves patients' survival rate and life quality. The keys to successful operation are proper preoperative selection of patients, fully revascularization during operation and appropriate peri operative management.