非体外循环冠状动脉旁路移植术在左心室功能低下患者中的应用

目的:分析左心室功能低下(EF<40%)冠心病患者,接受非体外循环冠状动脉旁路移植手术(OPCAB)的疗效,改进左心室功能低下冠心病患者的治疗策略。方法:回顾性分析2006年以来我院手术组对37例左心室功能低下的冠心病患者,行OPCAB后手术前后疗效的对比。结果:2例患者死亡,1例死于术后肺部感染,1例死于术后低心排出量综合征(低心排),病死率5%。21例患者使用主动脉内球囊反搏器(IABP),其中7例在术前放置,14例在术中或术后放置。35例患者术后左心室射血分数(EF值)较术前有明显改善(P<0.05);左心室舒张末期内径、左心室收缩末径均较术前下降(P<0.05)。结论:对于左心室功能低下的冠心病患者,OPCAB是一种有效的治疗方法。及时使用主动脉球囊反搏,以及合理应用正性肌力药物对于降低患者病死率,减少患者住院时间具有重要意义。

Off-pump coronary artery bypass grafting in patients with poor left ventricular function

Objective:To analysis the surgical results of patients with coronary heart disease and poor left ventricular function using Off-pump coronary artery bypass grafting(OPCAB).Methods:From 2006,37 patients with poor left ventricular function underwent OPCAB,and hemodynamic parameters were analyzed retrospectively.Results:Two patients died after operation,and the mortality was 5%.One patient died of pulmonary infection,and the other died of low output syndrome.Intra-aortic balloon pump was used in 21 cases.IABP was implanted in 7 cases pre-operatively,and it was inserted in 14 cases intra-or post-operatively.37 patients Ejection fraction of left ventricle improved significantly.Left ventricular end-diastolic diameter and left ventricular end-systolic diameter decreased dramatically after surgery.Conclusion:Off-pump coronary artery bypass grafting is a useful technique for patients with poor left ventricular function.Earlier IABP implantation and inotropic agents are useful to decrease the mortality and ICU stay.