左心功能低下冠心病患者的外科治疗

Surgical Treatment of Patients with Coronary Heart Disease with Hypofunction of Left Heart

摘要: 目的：为了总结合并严重左心功能不全冠心病患者行冠状动脉旁路移植术(CABG)外科治疗的临床经验，降低左心功能不全患者的住院死亡率及并发症发生率。方法：回顾性分析作者所在单位青岛大学附属医院近3年525例冠状动脉搭桥患者，其中左室功能不全(定义为左心室射血分数 ≤ 为35%)患者102例，总结纳入组病例的基本特征、术前共病、手术策略、围术期并发症、住院死亡率等。结果：其中使用乳内动脉桥患者：73例，住院死亡：27例，CABG：42例，OPCABG：60例。术后心肌梗死、术后低心排、术后肾衰竭、术后肺部感染为主要的术后并发症。围手术期不良事件发生的主要预测因子有：COPD、急诊手术、术前应用IABP、合并二尖瓣手术。结论：严重的左心室功能不全在普通心脏外科人群中很常见。左心功能低下冠心病患者冠状动脉搭桥术术后并发症风险高，死亡率高，但围手术期风险与术后远期存活率相比要低。

Abstract: Objective: To summarize the clinical experience of coronary artery bypass grafting (CABG) in the treatment of coronary heart disease with severe left ventricular insufficiency, and to reduce the in-hospital mortality and complication rate of patients with severe left ventricular insufficiency. Methods: A retrospective analysis was made on 525 patients with coronary artery bypass grafting in the affiliated Hospital of Qingdao University in recent 3 years, including 102 patients with left ventricular dysfunction (defined as left ventricular ejection fraction ≤ 35%). The basic characteristics, preoperative comorbidities, surgical strategies, perioperative complications and hospital mortality were summarized. Results: Among them, 73 cases were treated with internal mammary artery bridge, 27 cases died in hospital, 42 cases were CABG, and 60 cases were OPCABG. Postoperative myocardial infarction, postoperative low cardiac output, postoperative renal failure and postoperative pulmonary infection were the main postoperative complications. The main predictors of perioperative adverse events were COPD, emergency surgery, preoperative application of IABP and mitral valve surgery. Conclusion: Severe left ventricular dysfunction is common in general cardiac surgery. Patients with lower LVEF after cardiac surgery have a high risk of complications and mortality after coronary artery bypass grafting, but the operative mortality is relatively low. Among patients with left ventricular insufficiency, coronary artery bypass grafting with mitral valve surgery has the highest mortality. Accurate preoperative assessment and risk stratification are essential for these patients, and careful perioperative management is mandatory.