冠状动脉旁路移植术,非体外循环%心肌顿抑%超声心动描记术,三维%心室功能,左
冠狀動脈徬路移植術,非體外循環%心肌頓抑%超聲心動描記術,三維%心室功能,左
관상동맥방로이식술,비체외순배%심기돈억%초성심동묘기술,삼유%심실공능,좌
Coronary artery bypass graft,off-pump%Stunned myocardium%Echocardiography,three dimensional%Ventricular function,left
目的 观察心肌顿抑在冠状动脉旁路移植手术(CABG)前后的功能变化,明确CABG对弥漫性血管改变患者的再血管化意义.方法 36例左前降支近段99％以上狭窄的慢性闭塞冠心病患者来自哈尔滨医科大学附属第一医院心外科,在医院接受过非体外循环CABG治疗.全部患者于术前1周,术后10天、1个月、3个月应用实时三维超声心动图(RT-3DE)检查左室前降支基底段的前间隔和前壁、中间段的前间隔和前壁、心尖段的前壁和间隔6节段供血,观察手术前后左室前降支供血节段的局部舒张、收缩末期容积,局部、局部-整体射血分数,舒张、收缩末期6、4节段最大容积总和.结果 CABG术前1周和术后10天、1个月、3个月,前壁基底段、前间隔基底段、前壁中间段、前间隔中间段、心尖前壁、心尖间隔6节段舒张、收缩末期容积组间比较差异有统计学意义(F值分别为3.51、3.55、4.08、4.05、2.98、3.01,P均＜0.05；F值分别为4.51、4.55、4.08、3.00、2.96、2.99,P均＜0.05)；上述6节段术后3个月[(6.74±1.23)、(6.64±1.21)、(6.02±1.10)、(5.95±1.09)、(5.82±1.06)、(5.10±0.93)m1;(2.74±0.50)、(2.69±0.49)、(2.51±0.46)、(2.32±0.42)、(2.36±0.43)、(2.03±0.37)ml]与术前1周[(8.33±1.52)、(8.20±1.50)、( 7.43±1.36)、(7.36±1.34)、(7.19±1.31)、(6.29±1.15 )ml; (4.94±0.90)、(4.85±0.88)、(4.53±0.83)、(4.18±0.76)、(4.25±0.78)、(3.65±0.67)ml]比较,差异有统计学意义(P均＜ 0.05).6节段局部、局部-整体射血分数组间比较差异有统计学意义(F值分别为4.56、4.88、4.28、3.15、2.93、2.88,P均＜0.01或＜0.05;F值分别为5.56、5.28、4.98、5.15、3.03、2.78,P均＜0.01或＜0.05)；与术前1周比较,局部射血在术后1个月、局部-整体射血在术后10天、术后1个月有4节段发生明显改善(P均＜ 0.05),在术后3个月有6节段均发生明显改善(P均＜0.05).舒张末期6节段、4节段最大容积总和组间比较差异有统计学意义(F值分别为2.58、5.81,P＜0.05或＜0.01),术后10天开始下降,术后3个月[ (36.27±1.10)、(25.35±1.16)ml]与术前1周[(44.80±1.36)、(31.32±1.43)ml]比较差异有统计学意义(P均＜ 0.05)；收缩末期6节段、4节段最大容积总和组间比较差异有统计学意义(F值分别为5.77、5.57,P均＜0.01),术后10天开始下降,术后1个月[(16.40±0.48)、(11.58±0.51 )ml]、3个月[(14.65±0.45)、(10.26±0.46)ml]与术前1周[(26.40±0.80)、( 18.50±0.84)ml]比较差异有统计学意义(P均＜0.05).结论 心肌顿抑可以通过CABG治疗改善相应节段的心肌收缩、舒张功能和射血分数,弥漫性血管改变患者通过CABG治疗进行再血管化可以改善缺血区的心脏功能.
目的 觀察心肌頓抑在冠狀動脈徬路移植手術(CABG)前後的功能變化,明確CABG對瀰漫性血管改變患者的再血管化意義.方法 36例左前降支近段99％以上狹窄的慢性閉塞冠心病患者來自哈爾濱醫科大學附屬第一醫院心外科,在醫院接受過非體外循環CABG治療.全部患者于術前1週,術後10天、1箇月、3箇月應用實時三維超聲心動圖(RT-3DE)檢查左室前降支基底段的前間隔和前壁、中間段的前間隔和前壁、心尖段的前壁和間隔6節段供血,觀察手術前後左室前降支供血節段的跼部舒張、收縮末期容積,跼部、跼部-整體射血分數,舒張、收縮末期6、4節段最大容積總和.結果 CABG術前1週和術後10天、1箇月、3箇月,前壁基底段、前間隔基底段、前壁中間段、前間隔中間段、心尖前壁、心尖間隔6節段舒張、收縮末期容積組間比較差異有統計學意義(F值分彆為3.51、3.55、4.08、4.05、2.98、3.01,P均＜0.05；F值分彆為4.51、4.55、4.08、3.00、2.96、2.99,P均＜0.05)；上述6節段術後3箇月[(6.74±1.23)、(6.64±1.21)、(6.02±1.10)、(5.95±1.09)、(5.82±1.06)、(5.10±0.93)m1;(2.74±0.50)、(2.69±0.49)、(2.51±0.46)、(2.32±0.42)、(2.36±0.43)、(2.03±0.37)ml]與術前1週[(8.33±1.52)、(8.20±1.50)、( 7.43±1.36)、(7.36±1.34)、(7.19±1.31)、(6.29±1.15 )ml; (4.94±0.90)、(4.85±0.88)、(4.53±0.83)、(4.18±0.76)、(4.25±0.78)、(3.65±0.67)ml]比較,差異有統計學意義(P均＜ 0.05).6節段跼部、跼部-整體射血分數組間比較差異有統計學意義(F值分彆為4.56、4.88、4.28、3.15、2.93、2.88,P均＜0.01或＜0.05;F值分彆為5.56、5.28、4.98、5.15、3.03、2.78,P均＜0.01或＜0.05)；與術前1週比較,跼部射血在術後1箇月、跼部-整體射血在術後10天、術後1箇月有4節段髮生明顯改善(P均＜ 0.05),在術後3箇月有6節段均髮生明顯改善(P均＜0.05).舒張末期6節段、4節段最大容積總和組間比較差異有統計學意義(F值分彆為2.58、5.81,P＜0.05或＜0.01),術後10天開始下降,術後3箇月[ (36.27±1.10)、(25.35±1.16)ml]與術前1週[(44.80±1.36)、(31.32±1.43)ml]比較差異有統計學意義(P均＜ 0.05)；收縮末期6節段、4節段最大容積總和組間比較差異有統計學意義(F值分彆為5.77、5.57,P均＜0.01),術後10天開始下降,術後1箇月[(16.40±0.48)、(11.58±0.51 )ml]、3箇月[(14.65±0.45)、(10.26±0.46)ml]與術前1週[(26.40±0.80)、( 18.50±0.84)ml]比較差異有統計學意義(P均＜0.05).結論 心肌頓抑可以通過CABG治療改善相應節段的心肌收縮、舒張功能和射血分數,瀰漫性血管改變患者通過CABG治療進行再血管化可以改善缺血區的心髒功能.
목적 관찰심기돈억재관상동맥방로이식수술(CABG)전후적공능변화,명학CABG대미만성혈관개변환자적재혈관화의의.방법 36례좌전강지근단99％이상협착적만성폐새관심병환자래자합이빈의과대학부속제일의원심외과,재의원접수과비체외순배CABG치료.전부환자우술전1주,술후10천、1개월、3개월응용실시삼유초성심동도(RT-3DE)검사좌실전강지기저단적전간격화전벽、중간단적전간격화전벽、심첨단적전벽화간격6절단공혈,관찰수술전후좌실전강지공혈절단적국부서장、수축말기용적,국부、국부-정체사혈분수,서장、수축말기6、4절단최대용적총화.결과 CABG술전1주화술후10천、1개월、3개월,전벽기저단、전간격기저단、전벽중간단、전간격중간단、심첨전벽、심첨간격6절단서장、수축말기용적조간비교차이유통계학의의(F치분별위3.51、3.55、4.08、4.05、2.98、3.01,P균＜0.05；F치분별위4.51、4.55、4.08、3.00、2.96、2.99,P균＜0.05)；상술6절단술후3개월[(6.74±1.23)、(6.64±1.21)、(6.02±1.10)、(5.95±1.09)、(5.82±1.06)、(5.10±0.93)m1;(2.74±0.50)、(2.69±0.49)、(2.51±0.46)、(2.32±0.42)、(2.36±0.43)、(2.03±0.37)ml]여술전1주[(8.33±1.52)、(8.20±1.50)、( 7.43±1.36)、(7.36±1.34)、(7.19±1.31)、(6.29±1.15 )ml; (4.94±0.90)、(4.85±0.88)、(4.53±0.83)、(4.18±0.76)、(4.25±0.78)、(3.65±0.67)ml]비교,차이유통계학의의(P균＜ 0.05).6절단국부、국부-정체사혈분수조간비교차이유통계학의의(F치분별위4.56、4.88、4.28、3.15、2.93、2.88,P균＜0.01혹＜0.05;F치분별위5.56、5.28、4.98、5.15、3.03、2.78,P균＜0.01혹＜0.05)；여술전1주비교,국부사혈재술후1개월、국부-정체사혈재술후10천、술후1개월유4절단발생명현개선(P균＜ 0.05),재술후3개월유6절단균발생명현개선(P균＜0.05).서장말기6절단、4절단최대용적총화조간비교차이유통계학의의(F치분별위2.58、5.81,P＜0.05혹＜0.01),술후10천개시하강,술후3개월[ (36.27±1.10)、(25.35±1.16)ml]여술전1주[(44.80±1.36)、(31.32±1.43)ml]비교차이유통계학의의(P균＜ 0.05)；수축말기6절단、4절단최대용적총화조간비교차이유통계학의의(F치분별위5.77、5.57,P균＜0.01),술후10천개시하강,술후1개월[(16.40±0.48)、(11.58±0.51 )ml]、3개월[(14.65±0.45)、(10.26±0.46)ml]여술전1주[(26.40±0.80)、( 18.50±0.84)ml]비교차이유통계학의의(P균＜0.05).결론 심기돈억가이통과CABG치료개선상응절단적심기수축、서장공능화사혈분수,미만성혈관개변환자통과CABG치료진행재혈관화가이개선결혈구적심장공능.
Objective To evaluate the functional changes of stunned myocardium before and after coronary artery bypass graft(CABG) treatment,and clear the meaning of revascularization which CABG has brought to patients with diffused vascular changes.Methods A total of 36 patients with 99％ diffused coronary artery stenosis in left anterior descending branch underwent non-pump CABG treatment in the Department of Cardiothoracic Surgery the First affiliated hospital of Harbin Medical University.Real-time three-dimensional echocardiography (RT3DE) was repeatedly performed 1 week before operation and 10 days,1 month,and 3 months after CABG.Regional diastolic volumes,systolic volumes,ejection fractions,regional stroke volume to global diastolic volume and the values of abnormal segments before and after CABG were studied.Results One week before operation and 10 days,1 month and 3 months after CABG,the differences of volumes between groups in the last phases of diastole and systolic were statistically significant in anterior wall basement segment,anterior septal basement segment,anterior wall intercalary segment,anterior septal intercalary segment,anterior wall of apex cordis and septation of apex cordis(F =3.51,3.55,4.08,4.05,2.98,3.01,all P ＜ 0.05; F =4.51,4.55,4.08,3.00,2.96,2.99,all P ＜ 0.05).The values of the six segments mentioned above,3 months after operation[(6.74 ± 1.23),(6.64 ± 1.21),(6.02 ± 1.10),(5.95 ± 1.09),(5.82 ± 1.06),(5.10 ± 0.93)ml; (2.74 ± 0.50),(2.69 ± 0.49),(2.51 ± 0.46),(2.32 ± 0.42),(2.36 ± 0.43),(2.03 ± 0.37)ml] were compared with those of 1 week before operation[(8.33 ± 1.52),(8.20 ± 1.50),(7.43 ± 1.36),(7.36 ± 1.34),(7.19 ± 1.31),(6.29 ± 1.15)ml; (4.94 ± 0.90),(4.85 ± 0.88),(4.53 ± 0.83),(4.18 ± 0.76),(4.25 ± 0.78 ),(3.65 ± 0.67)ml],the differences were statistically significant (all P ＜ 0.05); the differences between groups in regional ejection fractions,regional-global ejection fractions were statistically significant(F =4.56,4.88,4.28,3.15,2.93,2.88,P ＜ 0.01 or ＜ 0.05; F =5.56,5.28,4.98,5.15,3.03,2.78,P ＜ 0.01 or ＜ 0.05).Compared with 1 week before the operation, 1 month after the operation in regional ejection fractions,10 days,1 month in regionalglobal ejection fractions after the operation,4 segments of them were significantly improved(all P ＜ 0.05) and 3 months after operation,all the 6 segments had been improved significantly(all P ＜ 0.05).The maximum volume of the sum of group difference of the 6 segments and the 4 segments in the last phase of diastole was statistically significant(F =2.58,5.81,P ＜ 0.05 or ＜ 0.01 ),and the summation began to decrease 10 days after the operation.The values of 3 months after operation[ (36.27 ± 1.10),(25.35 ± 1.16)ml] were compared with that of 1 week before operation[ (44.80 ± 1.36),(31.32 ± 1.43)ml ] the difference was statistically significant (all P＜ 0.05).The maximum volume summafion comparisons of 6 segments and 4 segments in the last phase of systolic had statistical significance(F =5.77,5.57,all P ＜ 0.01 ),and 10 days after the operation,the summation began to decrease.The values of 1 month[(16.4 0 ± 0.48),(11.58 ±0.51 )ml],and 3 months after operation[ (14.65 ± 0.45),(10.26 ± 0.46)ml],were compared with those of 1 week before operation[ (26.40 ± 0.80),(18.50 ± 0.84)ml],the differences were statistically significant (all P ＜ 0.05).Conclusions Stunned myocardium can be improved through CABG in myocardium systolic,diastole function and ejection fractions of the relevant segments and all of this have proved that patients undergoing CABG revascularization can improve the heart function of the ischemic area.
