激光心肌血运重建术治疗危重冠心病的临床分析

目的总结激光心肌血运重建术(TMLR)治疗心功能低下的冠状动脉粥样硬化性心脏病(冠心病)和冠状动脉旁路移植术(CABG)后患者的早期临床效果. 方法 103例行TMLR的冠心病患者,根据TMLR术前心功能情况和是否做过CABG,分为3组.心功能低下组11例,左心室射血分数(LVEF)<0.40;二次手术组9例,CABG术后行TMLR;对照组83例,LVEF正常. 均在心脏不停跳下行TMLR.术中采用食管超声心动图(TEE)证实营造透壁性孔道.观察术后早期患者临床情况,随访心绞痛和心功能的改善情况. 结果心功能低下组和二次手术组术后心功能低下、心肌梗死、早期并发症的发生与对照组比较无明显差别,3组患者术后心绞痛均较术前明显改善(P＜0.05),LVEF较术前增高(P＜0.05). 结论 TMLR治疗心功能低下和CABG后患者是安全有效的.针对不同患者采用不同的治疗方法,可降低心功能低下和CABG后患者的手术风险.

Clinical analysis of the consequence of transmyocardial laser revascularization for patients with coronary atherosclerotic heart disease

Objective To sum up and analyze the early postoperative result after transmyocardial laser revascularization (TMLR) in the treatment of patient with lower ejection fraction and patients who had previous coronary artery bypass grafting (CABG). Methods 103 patients were divided into 3 groups. Lower cardiac function group left ventricular ejection fraction (LVEF)<0.40]: 11 patients, previous CABG group: 9 patients, control group: 83 patients. TMLR were performed on beating heart. The formation of transmural ducts were confirmed by transesophageal echocardiography(TEE). The clinical conditions of the patients during the earlier postoperative period were observed. Finally, the improvement of angina pectoris and LVEF were followed up. Results In lower cardiac function group and previous CABG group, there was no significance difference in the incidence of left ventricular failure, acute myocardial infarction and earlier complication after TMLR compared with control group. There was significant improvement in angina pectoris (P<0.05) and LVEF in three groups (P< 0.05). Conclusions TMLR is safe and effective in treatment of patients with lower ejection fraction and previous CABG. According to different patients, using different treatments can reduce the operative risk of patients with lower ejection fraction and previous CABG.