体外循环辅助心脏不停跳冠状动脉旁路移植术在低射血分数患者中的应用

目的 对97例射血分数（EF）＜0.30的冠心病患者的体外循环辅助心脏不停跳冠状动脉旁路移植术（OPCAB）进行总结分析.方法 选择97例EF＜0.30的高危患者,全部采用体外循环辅助心脏不停跳冠状动脉旁路移植术,其中男性55例,女性42例.术前测定射血分数0.18～0.29（0.240±0.031）.合并心肌梗死史42例,不稳定型心绞痛49例,支架置入治疗史16例.NYHA心功能Ⅱ级39例、Ⅲ级35例、Ⅳ级23例.冠脉造影提示双支病变21例、多支病变65例、左主干病变11例,合并轻、中度二尖瓣反流43例,合并室壁瘤13例,左室血栓2例.超声心动图检查提示左心室舒张末期内径53～76 （61.3±4.2）mm.结果 97例患者均完成手术,平均远端吻合口（3.7±1.1）个,使用主动脉内球囊反搏37例,均在手术中安放.住院死亡2例.1例脑梗塞导致左侧肢体偏瘫,未愈出院,1例肺梗塞,保守治疗好转.随访2～21个月.出院后死亡3例,3例有心功能不全表现,需要长期强心利尿药物治疗.其余患者心功能良好,未再次接受心导管术.结论 低射血分数患者实施体外循环辅助心脏不停跳冠状动脉旁路移植手术有良好的可行性和近期效果,能有效降低手术与麻醉风险.

Application of extracorporeal circulation assisted off-pump coronary artery bypass grafting in patients with low ejection fraction

Objective To review 97 cases of off-pump coronary artery bypass grafting （OPCAB） in patients with left ventricular ejection fraction （LVEF） less than 0.3.Methods 97 cases of selected off pump coronary artery bypass grafting from patients with LVEF less than 0.3,whose mean left ventricular ejection fraction was 0.240±0.031,55 of male,42 of female.There were 42 cases of remote myocardial infarction,49 of unstable angina pectoris,16 of coronary artery stent.New York Heart Association（NYHA） class was 39 of Ⅱ,35 of Ⅲ,23 of Ⅳ.Coronary angiography revealed double-vessel disease in 21 cases,and triple or more-vessel disease in 65 cases,and left main stem disease in 11,whose combined 43 of midrange mitral regurgitation,13 of left ventricular aneurysm,2 of left ventricular thrombus.Preoperative echocardiographic examinations revealed a mean of left ventricular diastolic dimension （LVDD）（61.3±4.2）mm.Results 97 cases of OPCAB surgery were performed.The mean number of distal anastomotic stoma was 3.7±1.1,intra-aortic balloon pump was used in 3,all balloons were inserted at operations.Two patients died in hospital and one patient cerebral infarction induced left hemiplegia,one patient with pulmonary infarction.In the follow-up 2-21 month,3 patients died,3 patients with heart failure required long term medication.Conclusion OPCAB has a good feasibility and a short-term favorite effect in patients with low ejection fraction,could obviously decrease the risk of the surgery and anaesthesia