摘要
目的 评价冠状动脉旁路移植术 (CABG)对重症缺血性心肌病的治疗效果。方法 1991年至 1998年间共收治 44例重症缺血性心肌病病人 ,单纯左室射血分数 (LVEF)≤ 0 35 ,无室壁瘤和其他合并症。平均左室舒张末直径 (LVEDD)为 (6 1 0± 10 5 )mm。PET试验证明 ,缺血心肌部位仍有存活心肌。 35例应用左乳内动脉 (LIMA) ,均与前降支吻合 ;其余用大隐静脉 ,平均每例搭桥 2 5根。 1例术后第 4d死于室颤。 3例术后应用主动脉内球囊反搏 (IABP)。平均随访 (4 2 5± 12 6 )个月 ,出院后 1周 1例死于严重心律失常。平均LVEF为 0 49± 0 11,较术前有显著提高 (P <0 0 5 )。平均LVEDD为 (5 6 5±7 3)mm ,较术前有所缩小。结论 CABG在重症缺血性心肌病中的疗效取决于存活心肌的多少和冠状动脉再血管化的程度。PET心肌显像是目前临床上判断存活心肌的主要诊断方法。围术期处理注意控制高危因素 ,术中加强心肌保护。尽可能缩短主动脉阻断时间 ,停机困难者应尽早应用IABP 。
Objective To evaluate the effect of coronary artery bypass graft(CABG) in the treatment of severe ischemic cardiomyopathy. Method 44 patients with severe ischemic cardiomyopathy, isolated LVEF less than 35% received CABG. Average LVEF was 30 2%±7 5%. Mean LVEDD was (61 5±10 6)?mm. The presence of living myocardium in the area of ischemia was PET. An average of 2 5 grafts was performed per patient. Result One patient died from ventricular arrhythmia fourth day postoperatively. IABP was used in four patients. The mean follow up interval was 42 5 months. LVEF was significantly increased (49 5%±10 6%,P<0 05) and LVEDD was decreased to 59 6?mm(P>0 05) postoperatively. Conclusion The effect of CABG in severe ischemic cardiomyopathy depends on the amount of living myocardium present. It is important to control hypertension and diabetes before CABG. IABP should be applied early when weanning from pump is difficult.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2000年第6期332-334,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
