左心室射血分数在评估冠状动脉旁路移植患者中的应用价值

目的:评估左心室射血分数(left ventricular ejection fraction,LVEF)在行冠状动脉旁路移植术(coronary artery bypass graft,CABG)患者中的应用价值.方法:2004至2005年北京大学第一医院心外科为215例冠状动脉粥样硬化心脏病患者行CABG,其中36 例(16.7%)术前超声心动显示LVEF《0.40,平均0.30±0.08,为低LVEF组;179例(83.3%)LVEF≥0.40,平均0.53±0.11,为正常LVEF组.比较两组术前、术中及术后相关指标,进行统计学分析.结果:低LVEF组心脏手术风险评估欧洲系统(EuroSCORE)与正常LVEF组相比,差异有统计学意义(6.4±1.7 vs 3.6±0.8,P《0.05).低LVEF组术前伴二尖瓣中度以上返流及室壁瘤形成的患者比例高于正常LVEF组(55.6% vs 7.8%,P《0.05),此部分患者术中需CABG联合二尖瓣成形/置换或室壁瘤成形术.低LVEF组手术死亡率高于正常LVEF组(5.5% vs 2.8%,P《0.05).低LVEF组手术早期低心排出量综合征发生率高于正常LVEF组(58.3% vs 10%,P《0.05).低EF组34例存活患者术后症状均消失,且术后7～10 d LVEF值与术前比较差异均具统计学意义(0.47±0.11 vs 0.30±0.08,P《0.05).结论:LVEF《0.40 的CABG患者手术风险增加,且多数伴有二尖瓣中度以上返流和室壁瘤,需同期手术纠治.

Value of left ventricular ejection fraction in coronary artery bypass grafting patients

OBJECTIVE: To evaluate the role of the left ventricular ejection fraction (LVEF) in coronary artery bypass grafting(CABG)patients. METHODS: From 2004 to 2005,215 patients underwent CABG and there were 36 cases with LVEF<0.40(low LVEF group) whereas 179 cases with LVEF>0.40(normal LVEF group). Correlative data of the two groups were compared and analyzed statistically. RESULTS: Compared with the normal EF group, the EuroSCORE of the low EF group was much higher (mean 6.4+/-1.7) and many more patients of the low EF group had concomitant moderate to severe mitral valve insufficiency and aneurysm that needed simultaneous surgical operation(55.6%).Two patients died in hospital(5.5%)in the low EF group whereas five patients in the normal EF group(2.8%, P<0.05).In the low EF group,34 survivors(94.5%)were free of angina. Low cardiac output was the main postoperative complication. The mean EF was significantly improved postoperatively (mean 0.47+/-0.11)(P<0.05). CONCLUSION: EF<0.40 is indeed a risk factor for patients with coronary artery disease. Most of them have concomitant moderate to severe mitral valve insufficiency and aneurysm that need simultaneous surgical operations. The early surgical result of them is of satisfaction.