中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

合并慢性左心功能不全心外科手术患者的综合治疗

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目的 总结神经内分泌抑制理念下综合治疗心力衰竭合并慢性左心功能严重受损患者的临床经验。 方法 2014 年 3 月至 2016 年 5 月我科共收治左心功能严重受损的心外科手术患者 65 例,其中男 49 例、女 16 例,年龄 37~80(61.3±11.4)岁。入选标准为术前超声心动图提示左室射血分数(LVEF)<40%,排除急性心肌梗死导致的急性心功能衰竭。对纳入患者采用神经内分泌抑制理念下的综合治疗。 结果 全组体外循环 40 例,辅助时间 55~400(148.1± 69.8)min;主动脉阻断 35 例,阻断时间 44~203(95.7±39.6)min。使用主动脉内球囊反搏(IABP)辅助 3 例。住院死亡 2 例(3.1%)。随访 1~27(13.4±6.4)个月,心功能明显改善,心脏明显缩小。三腔起搏器植入 4 例,再入院 2 例,随访死亡 2 例(3.1%),再次心血管事件 2 例,无再次手术,其余有症状不稳定者经门诊药物剂量调整均能稳定。 结论 初步临床结果表明神经内分泌抑制理念下综合治疗合并慢性左心功能严重受损的心力衰竭患者可以有效降低住院死亡率,提高生活质量。

Objective To explore the use of comprehensive treatment including drugs, devices and electrophysiology for heart failure patients with surgical indications. Methods We collected the clinical data of 65 consecutive cardiac surgical patients with chronic left ventricular dysfunction in our department between March 2014 and May 2016. There were 49 males and 16 females with an average age of 61.3±11.4 years ranging from 37 to 80 years. Their left ventricular ejection fraction was less than 40%. Patients with ventricular dysfunction caused by acute myocardial infarction were excluded. A comprehensive treatment strategy was performed according to patients’ individual disease. Results Fourty patients underwent cardiopulmonary bypass with asisting time of 55-400 (148.1±69.8) min; 35 patients needed cross-clamping with time of 44-203 (95.7±39.6) min. Intra-aortic balloon pump (IABP) was assisted in 3 patients. Two patients died in hospital. During the follow-up of 13.4 months, the patients’ cardiac function significantly improved and the heart size reduced. Two patients died and two were readmitted for heart failure. Four patients underwent cardiac pacemaker implantation. Other patients with unstable symptoms were stabilized after medical dose adjustment. Conclusion Under the concept of neuroendocrine inhibition, the comprehensive treatment for heart failure can effectively reduce surgical mortality and improve the patient’s quality of life.

关键词: 心力衰竭; 外科治疗; 神经内分泌抑制

Key words: Heart failure; surgery; neuroendocrine inhibition theory

引用本文: 李健, 张卫, 顾伟礼, 朱丹. 合并慢性左心功能不全心外科手术患者的综合治疗. 中国胸心血管外科临床杂志, 2018, 25(4): 313-316. doi: 10.7507/1007-4848.201707033 复制

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