冠状动脉弥漫性病变并低射血分数患者的外科治疗

目的 探讨冠状动脉弥漫性病变并低射血分数患者的外科治疗方法与疗效.方法 冠状动脉弥漫性病变患者68例,依射血分数高低分为两组：组1,34例,男20例,女14例;年龄36 ～ 72岁,平均（59.3±7.0）岁;左室射血分数（LVEF） ＜40％.组2,34例,男24例,女10例;年龄38～79岁,平均（62.2±7.1）岁;40％≤LVEF＜ 50％.狭窄段＜5 mm,内膜剥脱术同期搭桥.狭窄段≥5 mm,狭窄近、远端各搭一支桥或序贯搭桥.结果 全组左心室舒张末径较术前明显减小（52 ±2）mm vs （60 ±4）mm,t =7.32,P＜0.05）];LVEF较术前明显增高（45±17）％vs （34±15）％,t=4.770,P＜0.05],与术前比较差异有统计学意义.手术前后左室舒张末径变化值（12.4 ±5.6）mm vs （13.65 ±5.6）mm],两组比较差异无统计学意义（P＞0.05）.两组手术前后左室变化值（12.24 ±5.6）mm vs（13.65±3.2）mm],两组比较差异无统计学意义（P＞0.05）;两组手术前后LVEF变化值（10.12±3.6）％vs（10.32±5.6）％],两组比较差异无统计学意义（P＞0.05）.结论 外科治疗冠状动脉弥漫性病变并低射血分数患者安全、有效.

Surgical treatment of diffuse coronary artery lesions with low ejection fraction

Objective To explore the surgical methods and efficiency in treating diffuse coronary artery lesions with low ejection fraction（EF）.Methods According to the level of EF,68 cases of diffuse coronary lesions with low left ventricular ejection fraction （LVEF） were divided into group 1 （LVEF ＜40％）and 2（40％ ≤LVEF ＜50％）.In the group 1,there were 34 patients,including 20 males and 10 females,with an average age of（59.3 ± 7.0）years（range 36-72 years）.In the group 2,there were 34 patients,including 24 males and 10 females,with an average age of（62.2 ± 7.1） years （range 38-79years）.If the stenosis was less than 5mm,endarterectomy with coronary artery bypass grafting would be performed.If the stenosis was more than or equal to 5mm,proximal and distal bridge vessels or sequential bridge vessels would be grafted.Results After the operation,the average left ventricular end-diastolic diameter in all patients was significantly decreased （52 ± 2）mm vs （60 ± 4） mm,t =7.32,P ＜ 0.05） and the average LVEF was not significantly higher （45％ ± 17％） vs（34％ ± 15％）,t =4.770,P ＜0.05）.There was no significant difference in the postoperative change of left ventricular end-diastolic diameter （12.4 ± 5.6）mm vs（13.65 ± 5.6）mm,P ＞ 0.05].There was no significant difference in the postoperative change of left ventricle （12.24 ± 5.6） mm vs （13.65 ± 3.2） mm,P ＞ 0.05].The postoperative change of LVEF was not significant between the groups （10.12 ± 3.6） ％ vs （10.32 ± 5.6） ％,P ＞ 0.05）.Conclusion Surgical treatment of diffuse coronary artery lesions with low EF is safe and effective.