经食管超声心动图评价冠状动脉搭桥术后左心室功能

Study on left ventricular function after off-pump coronary artery bypass with transesophageal echocardiography

目的 探讨经食管超声心动图 (TEE)检测肺静脉、二尖瓣血流频谱及左心室射血分数 (LVEF)在非体外循环冠状动脉搭桥术 (OPCAB)后左心室功能的变化。方法 用TEE对 2 1例冠心病患者OPCAB前及术后 1个月检测肺静脉、二尖瓣血流频谱以及左心室每搏量 (SV) ,心输出量 (CO)和LVEF。结果 OPCAB前后肺静脉血流的心房收缩峰值流速 (PVa)、收缩期 (PVs)和舒张期 (PVd)峰值流速差异有显著性意义 (P <0 .0 5) ;二尖瓣血流舒张早期峰值流速 (E)和二尖瓣舒张早期与二尖瓣舒张晚期血流速度比值较术前明显增加 (P <0 .0 5) ;SV测值较术前增加 (P <0 .0 5) ;LVEF和CO增加但差异无显著性意义。结论 OPCAB能在短期内显著改善左心室功能 ,尤其对左心室舒张功能 ,TEE为临床提供了一种可靠评价血管重建术的方法。

Objective To evaluate the impact of the off -pump coronary artery bypass (OPCAB) on left ventricular(LV) function with transesophageal echocardiography(TEE). Methods Blood flow velocities of pulmonary vein (PV) and mitral valve (MV) were performed in 21 patients with coronary heart disease and myocardial infarction two weeks pre-OPCAB, and the left ventricular SV, CO and LVEF were measured by biplane Simpson′s method, the data were compared with the results observed one month post-OPCAB. Results The peak flow velocities of PV had significant difference between pre- and post-OPCAB(P< 0.05 - 0.01 ).MVe wave and MVe/MVa of MV were increased significantly as well(P< 0.05 ). LVEF and CO were also improved obviously, but there was no statistical significance. Only the SV had increased significantly(P< 0.05 ). Conclusions OPCAB can improve LV function, especially systolic LV function significantly in short-term. TEE is a highly reliable method to quantitatively evaluate the clinical results of coronary revascularization.