中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
48期
3403-3406
,共4页
陈鑫%邱志兵%徐明%蒋英硕%汪黎明%史宏伟%穆心苇%陈绪军%黄福华%肖立琼%刘陪生%王睿
陳鑫%邱誌兵%徐明%蔣英碩%汪黎明%史宏偉%穆心葦%陳緒軍%黃福華%肖立瓊%劉陪生%王睿
진흠%구지병%서명%장영석%왕려명%사굉위%목심위%진서군%황복화%초립경%류배생%왕예
心肌梗死%心脏室壁瘤%冠状动脉分流术%心室重建
心肌梗死%心髒室壁瘤%冠狀動脈分流術%心室重建
심기경사%심장실벽류%관상동맥분류술%심실중건
Myocardial infarction%Heart aneurysm%Coronary artery bypass%Left ventricular reconstruction
目的 探讨心肌梗死后左室室壁瘤的外科心室重建术治疗的临床经验、手术效果和术后左室重构的变化.方法 回顾性分析1997年1月至2009年12月我院194例心肌梗死后左室室壁瘤行外科心室重建术治疗患者临床资料、手术方法 和随访结果 ,其中线性缝合组57例,补片心室成形组137例;对比分析手术前后用超声心动图(UCG)检测左室重构的变化.用Kaplan-Meier法进行生存率分析.结果 194例患者均手术顺利,平均体外循环时间(103±35)min,主动脉阻断时间(62±26)min;围术期死亡8例(4.1%).其余患者术后心绞痛均缓解,心功能得到明显改善.Kaplan-Meier 法分析两组生存率差异无统计学意义(P=0.587).术后心室重构变化显示:线性缝合组手术前后心室重构变化差异无统计学意义(P＞0.05);而补片心室成形组心室重构变化术后2周、6个月、1年和5年均较术前小(P＜0.05);左室收缩末容积(LVESV)由(129±27)ml减小到(65±8)ml,左室收缩末容积指数(LVESVI)由(104±14)ml/m2减小到(44±6)ml/m2;且以左室射血分数(LVEF)＜35%亚组减小最明显.而LVEF呈进行性增加,由术前42%±11%增加到52%±7%(P＜0.05).结论 外科心室重建治疗心肌梗死后左室室壁瘤是非常有效的,手术方法 的选择取决于室壁瘤的大小与范围,线性缝合和心内补片心室成形均可取得较满意的手术效果,术后左室容积明显减小,心脏功能改善.
目的 探討心肌梗死後左室室壁瘤的外科心室重建術治療的臨床經驗、手術效果和術後左室重構的變化.方法 迴顧性分析1997年1月至2009年12月我院194例心肌梗死後左室室壁瘤行外科心室重建術治療患者臨床資料、手術方法 和隨訪結果 ,其中線性縫閤組57例,補片心室成形組137例;對比分析手術前後用超聲心動圖(UCG)檢測左室重構的變化.用Kaplan-Meier法進行生存率分析.結果 194例患者均手術順利,平均體外循環時間(103±35)min,主動脈阻斷時間(62±26)min;圍術期死亡8例(4.1%).其餘患者術後心絞痛均緩解,心功能得到明顯改善.Kaplan-Meier 法分析兩組生存率差異無統計學意義(P=0.587).術後心室重構變化顯示:線性縫閤組手術前後心室重構變化差異無統計學意義(P＞0.05);而補片心室成形組心室重構變化術後2週、6箇月、1年和5年均較術前小(P＜0.05);左室收縮末容積(LVESV)由(129±27)ml減小到(65±8)ml,左室收縮末容積指數(LVESVI)由(104±14)ml/m2減小到(44±6)ml/m2;且以左室射血分數(LVEF)＜35%亞組減小最明顯.而LVEF呈進行性增加,由術前42%±11%增加到52%±7%(P＜0.05).結論 外科心室重建治療心肌梗死後左室室壁瘤是非常有效的,手術方法 的選擇取決于室壁瘤的大小與範圍,線性縫閤和心內補片心室成形均可取得較滿意的手術效果,術後左室容積明顯減小,心髒功能改善.
목적 탐토심기경사후좌실실벽류적외과심실중건술치료적림상경험、수술효과화술후좌실중구적변화.방법 회고성분석1997년1월지2009년12월아원194례심기경사후좌실실벽류행외과심실중건술치료환자림상자료、수술방법 화수방결과 ,기중선성봉합조57례,보편심실성형조137례;대비분석수술전후용초성심동도(UCG)검측좌실중구적변화.용Kaplan-Meier법진행생존솔분석.결과 194례환자균수술순리,평균체외순배시간(103±35)min,주동맥조단시간(62±26)min;위술기사망8례(4.1%).기여환자술후심교통균완해,심공능득도명현개선.Kaplan-Meier 법분석량조생존솔차이무통계학의의(P=0.587).술후심실중구변화현시:선성봉합조수술전후심실중구변화차이무통계학의의(P＞0.05);이보편심실성형조심실중구변화술후2주、6개월、1년화5년균교술전소(P＜0.05);좌실수축말용적(LVESV)유(129±27)ml감소도(65±8)ml,좌실수축말용적지수(LVESVI)유(104±14)ml/m2감소도(44±6)ml/m2;차이좌실사혈분수(LVEF)＜35%아조감소최명현.이LVEF정진행성증가,유술전42%±11%증가도52%±7%(P＜0.05).결론 외과심실중건치료심기경사후좌실실벽류시비상유효적,수술방법 적선택취결우실벽류적대소여범위,선성봉합화심내보편심실성형균가취득교만의적수술효과,술후좌실용적명현감소,심장공능개선.
Objective To explore the clinical experiences, efficacies and postoperative left ventricular remodeling changes of surgical ventricular reconstruction in the treatment of post-infarction left ventricular aneurysm. Methods The investigators reviewed retrospectively the clinical data, operative approaches and follow-up outcomes of consecutive 194 patients with post-infarction left ventricular aneurysm,who underwent surgical ventricular reconstruction between January 1997 and December 2009. There were 54cases in the linear group and 137 cases in the endoventricular patch plasty group. The changes of ventricular remodeling were measured by peri-operative and follow-up echocardiography. Results All patients underwent surgery with a mean cardiopulmonay bypass duration of ( 103 ± 35 ) min and aortic cross clamp duration of (62 ±26)min. There were 8 per-operative deaths with a mortality rate of 2.2%. Angina pectoris of other cases disappeared and heart function greatly improved. After operation, the ventricular remodeling results showed that in the linear group, there was not significant difference in the changes of ventricular remodeling of post-op 2 weeks, 6 months, 1 year and 5 years versus pre-operation. However, in the endoventricular patch group, the changes of ventricular remodeling of post-op 2 weeks and follow-up 6months versus pre-operation were significantly reduced( P ＜0.05). End-systolic volume (LNESV) reduced from ( 129 ± 27 ) ml to ( 65 ± 8 ) ml and end-systolic volume index ( LVESVI ) decreased from ( 104 ± 14 )ml/m2 to (44 ± 6) ml/m2 and the subgroup of LVEF ＜ 35% was the most significant in the changes of LVESV and LVESVI. But LVEF improved significantly at post-operation and follow-up (from preoperation 42% ± 11% to 52% ± 7% during follow-up). Conclusions For patients with infarction left ventricular aneurysm, left ventricular reconstruction is quite effective. The choice of operative approaches is determined ty the size and range of ventricular aneurysm. Both string suture and endoventricular patch plasty technique can yield similarly satisfactory surgical outcomes. After operation, ventricular volume significantly decreases and cardiac function greatly improves.
