冠心病合并左心室扩大患者OPCABG手术效果的临床分析
发布时间：2018-08-02 14:41
【摘要】：研究目的通过回顾临床资料,分析冠心病合并左心室扩大的原因,并讨论此类患者行OPCABG的手术可行性、安全性及手术效果。资料与方法回顾性分析山东省立医院心脏外科从2012年1月至2017年1月收治的冠心病合并左心室扩大患者57例,其中女性12例(21.1%),男性45例(78.9%),年龄在44～78岁,平均年龄(62±7.8)岁。研究对象的纳入标准包括:①冠心病诊断明确,冠状动脉造影示多支病变;②心脏超声示左室舒张末径增大(女性50mm,男性55mm)。排除标准包括:①中度以上缺血性二尖瓣关闭不全、二尖瓣腱索断裂或乳头肌断裂、室壁瘤等器质性病变引起的左室扩大;②非冠心病原因的器质性心脏病(如瓣膜退行性变、风湿性心脏病、扩张性心肌病等)引起的左室扩大。全组患者均行OPCABG,术中根据具体情况,一般首先完成LIMA与LAD的搭桥,然后先将桥血管近端与主动脉吻合,后将桥血管远端依次与靶血管序贯吻合。通过电话、短信、微信及电子邮件对出院患者进行随访,并对其OPCABG前后的病情变化进行对比。结果1.患者术中均未出现因循环状态不稳定,而临时改为体外循环下CABG的情况,围术期无死亡病例。2.患者随访时间为出院后1个月～60个月(平均15个月),随访期间无死亡病例。随访患者症状较术前明显改善,NYHAⅠ级32例,Ⅱ级24例,Ⅲ级1例。3.术后7天、随访时测左室舒张末径(LVEDD)均较术前显著减小,有统计学差异(P0.001),而术后7天与随访时之间无统计学差异(P0.05)。4.随访时测左室射血分数(LVEF)较术前、术后7天显著升高,有统计学差异(P0.01),而术后7天与术前之间无统计学差异(P0.05)。5.术前存在轻度二尖瓣关闭不全的患者包括38例,其中,术后36例反流程度未见加重,2例反流消失;术前存在轻中度二尖瓣关闭不全的患者包括11例,其中,术后8例改善至轻度,2例反流消失,1例反流未改善。结论本组病例显示:1.OPCABG可以安全适用于冠心病合并左心室扩大的患者。2.OPCABG术中首先完成LIMA与LAD的搭桥,然后先将桥血管近端与主动脉吻合,后将桥血管远端由近及远与靶血管序贯吻合,可依次改善冠脉血供,有利于术中循环状态的稳定。3.OPCABG可以改善冠心病合并左心室扩大患者的左心功能,恢复左心室的空间构象,主要表现为左室舒张末径缩小、左室射血分数提高、轻中度二尖瓣关闭不全反流情况减轻。
[Abstract]:Objective to review the clinical data and analyze the causes of coronary heart disease complicated with left ventricular enlargement, and discuss the feasibility, safety and effect of OPCABG in these patients. Materials and methods from January 2012 to January 2017, 57 cases of coronary heart disease complicated with left ventricular enlargement in Shandong Provincial Hospital were retrospectively analyzed. Among them, 12 cases (21.1%) were female and 45 cases (78.9%) were male. The average age was (62 卤7.8) years old. The inclusion criteria included a definite diagnosis of coronary artery disease at 1: 1 and an increase in left ventricular end-diastolic diameter (50 mm in female, 55mm in male) on multivessel echocardiography. Exclusion criteria include: 1 or more moderate ischemic mitral insufficiency, rupture of mitral chordae tendons or rupture of papillary muscles, left ventricular dilatation caused by organic lesions such as ventricular aneurysms, and non-coronary heart disease (such as valvular degeneration). Rheumatic heart disease, dilated cardiomyopathy, etc. All patients underwent OPCABG. According to the specific conditions, the bypass graft of LIMA and LAD was completed first, then the proximal end of the graft vessel was anastomosed with the aorta, and then the distal end of the graft vessel was anastomosed with the target vessel sequentially. The patients were followed up by phone, short message, WeChat and email, and the changes before and after OPCABG were compared. Result 1. During the operation, there were no cases of CABG under cardiopulmonary bypass (CPB) because of the unstable circulation state, and there were no cases of death in perioperative period. 2. The follow-up period was 1 ~ 60 months (mean 15 months) after discharge. There were 32 cases of NYHA grade 鈪，
本文编号：2159762
[Abstract]:Objective to review the clinical data and analyze the causes of coronary heart disease complicated with left ventricular enlargement, and discuss the feasibility, safety and effect of OPCABG in these patients. Materials and methods from January 2012 to January 2017, 57 cases of coronary heart disease complicated with left ventricular enlargement in Shandong Provincial Hospital were retrospectively analyzed. Among them, 12 cases (21.1%) were female and 45 cases (78.9%) were male. The average age was (62 卤7.8) years old. The inclusion criteria included a definite diagnosis of coronary artery disease at 1: 1 and an increase in left ventricular end-diastolic diameter (50 mm in female, 55mm in male) on multivessel echocardiography. Exclusion criteria include: 1 or more moderate ischemic mitral insufficiency, rupture of mitral chordae tendons or rupture of papillary muscles, left ventricular dilatation caused by organic lesions such as ventricular aneurysms, and non-coronary heart disease (such as valvular degeneration). Rheumatic heart disease, dilated cardiomyopathy, etc. All patients underwent OPCABG. According to the specific conditions, the bypass graft of LIMA and LAD was completed first, then the proximal end of the graft vessel was anastomosed with the aorta, and then the distal end of the graft vessel was anastomosed with the target vessel sequentially. The patients were followed up by phone, short message, WeChat and email, and the changes before and after OPCABG were compared. Result 1. During the operation, there were no cases of CABG under cardiopulmonary bypass (CPB) because of the unstable circulation state, and there were no cases of death in perioperative period. 2. The follow-up period was 1 ~ 60 months (mean 15 months) after discharge. There were 32 cases of NYHA grade 鈪，
本文编号：2159762
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