【摘要】：研究目的通過回顧臨床資料,分析冠心病合并左心室擴(kuò)大的原因,并討論此類患者行OPCABG的手術(shù)可行性、安全性及手術(shù)效果。資料與方法回顧性分析山東省立醫(yī)院心臟外科從2012年1月至2017年1月收治的冠心病合并左心室擴(kuò)大患者57例,其中女性12例(21.1%),男性45例(78.9%),年齡在44～78歲,平均年齡(62±7.8)歲。研究對(duì)象的納入標(biāo)準(zhǔn)包括:①冠心病診斷明確,冠狀動(dòng)脈造影示多支病變;②心臟超聲示左室舒張末徑增大(女性50mm,男性55mm)。排除標(biāo)準(zhǔn)包括:①中度以上缺血性二尖瓣關(guān)閉不全、二尖瓣腱索斷裂或乳頭肌斷裂、室壁瘤等器質(zhì)性病變引起的左室擴(kuò)大;②非冠心病原因的器質(zhì)性心臟病(如瓣膜退行性變、風(fēng)濕性心臟病、擴(kuò)張性心肌病等)引起的左室擴(kuò)大。全組患者均行OPCABG,術(shù)中根據(jù)具體情況,一般首先完成LIMA與LAD的搭橋,然后先將橋血管近端與主動(dòng)脈吻合,后將橋血管遠(yuǎn)端依次與靶血管序貫吻合。通過電話、短信、微信及電子郵件對(duì)出院患者進(jìn)行隨訪,并對(duì)其OPCABG前后的病情變化進(jìn)行對(duì)比。結(jié)果1.患者術(shù)中均未出現(xiàn)因循環(huán)狀態(tài)不穩(wěn)定,而臨時(shí)改為體外循環(huán)下CABG的情況,圍術(shù)期無死亡病例。2.患者隨訪時(shí)間為出院后1個(gè)月～60個(gè)月(平均15個(gè)月),隨訪期間無死亡病例。隨訪患者癥狀較術(shù)前明顯改善,NYHAⅠ級(jí)32例,Ⅱ級(jí)24例,Ⅲ級(jí)1例。3.術(shù)后7天、隨訪時(shí)測左室舒張末徑(LVEDD)均較術(shù)前顯著減小,有統(tǒng)計(jì)學(xué)差異(P0.001),而術(shù)后7天與隨訪時(shí)之間無統(tǒng)計(jì)學(xué)差異(P0.05)。4.隨訪時(shí)測左室射血分?jǐn)?shù)(LVEF)較術(shù)前、術(shù)后7天顯著升高,有統(tǒng)計(jì)學(xué)差異(P0.01),而術(shù)后7天與術(shù)前之間無統(tǒng)計(jì)學(xué)差異(P0.05)。5.術(shù)前存在輕度二尖瓣關(guān)閉不全的患者包括38例,其中,術(shù)后36例反流程度未見加重,2例反流消失;術(shù)前存在輕中度二尖瓣關(guān)閉不全的患者包括11例,其中,術(shù)后8例改善至輕度,2例反流消失,1例反流未改善。結(jié)論本組病例顯示:1.OPCABG可以安全適用于冠心病合并左心室擴(kuò)大的患者。2.OPCABG術(shù)中首先完成LIMA與LAD的搭橋,然后先將橋血管近端與主動(dòng)脈吻合,后將橋血管遠(yuǎn)端由近及遠(yuǎn)與靶血管序貫吻合,可依次改善冠脈血供,有利于術(shù)中循環(huán)狀態(tài)的穩(wěn)定。3.OPCABG可以改善冠心病合并左心室擴(kuò)大患者的左心功能,恢復(fù)左心室的空間構(gòu)象,主要表現(xiàn)為左室舒張末徑縮小、左室射血分?jǐn)?shù)提高、輕中度二尖瓣關(guān)閉不全反流情況減輕。
[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 鹵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，

本文編號(hào)：2159762