论文部分内容阅读
目的:探究缺血性心肌病患者行冠状动脉旁路移植术(CABG)进行血运重建后，左心室射血功能的获益及其影响因素。方法:回顾性分析2015年3月至2019年3月于青岛市市立医院行CABG、术前左心室射血分数(LVEF)在30%～40%之间的226例缺血性心肌病患者资料，随访至术后6个月，观察LVEF恢复情况，LVEF增加≥10%为恢复良好组，LVEF增加<10%为恢复不良组，分析可能造成差异的临床、实验室、超声心动图等相关因素。结果:226例患者中，121例(53.5%)术后左心室功能恢复良好。单因素分析显示，缺血性心肌病(30%≤LVEF≤40%)患者术后LVEF恢复情况与既往心肌梗死、术前心绞痛发作、N末端B型利钠肽原(NT-proBNP)水平、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)和左心室舒张末期容积(LVEDV)有关。多因素分析显示，术前无心绞痛发作、LVEDD增大是缺血性心肌病(30%≤LVEF≤40%)患者术后LVEF恢复不良的独立危险因素(n OR＝3.898、1.214，n P<0.05)，其中LVEDD≥60 mm与其恢复不良存在相关性(χn 2＝8.631，n OR＝2.214，95% n CI为1.252～3.981，n P＝0.005)。LVEDD≥60 mm预测缺血性心肌病(30%≤LVEF≤40%)患者术后LVEF恢复不良的灵敏度为74.6%，特异度为47.5%。n 结论:LVEDD增大、手术近期无心绞痛发作是缺血性心肌病(30%≤LVEF≤40%)患者CABG术后LVEF恢复不良的独立危险因素，LVEDD≥60 mm可作为术前射血功能获益较小的预测指标。“,”Objective:To investigate the benefit of left ventricular ejection function and its influencing factors in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG) after revascularization.Methods:A retrospective analysis was performed on 226 patients with ischemic cardiomyopathy who underwent CABG and a preoperative left ventricular ejection fraction (LVEF) between 30% and 40% in Qingdao Municipal Hospital from March 2015 to March 2019. During the follow-up to 6 months after surgery, the recovery of LVEF was observed. The increase of LVEF was ≥10% in the recovery group, and the increase in LVEF was <10% in the recovery group. The clinical, laboratory, and echocardiographic factors that may cause differences were analyzed.Results:Of the 226 patients, 121(53.5%) had good left ventricular function recovery. Univariate analysis showed that the recovery of LVEF in patients with ischemic cardiomyopathy (30% ≤LVEF≤40%) was related to myocardial infarction, preoperative angina pectoris attack, N-terminal pro-B-type natriuretie peptide (NT-proBNP) level, left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and left ventricular end diastolic volume (LVEDV). Multivariate analysis showed that increased LVEDD and non-angina pectoris were independent risk factors for poor LVEF recovery in patients with ischemic cardiomyopathy (30%≤LVEF≤40%) (n OR=3.898, 1.214, n P<0.05). LVEDD≥60 mm was significantly associated with poor recovery (χn 2=8.631, n OR=2.214, 95% n CI=1.252-3.981, n P=0.005). The sensitivity and specificity of LVEDD≥60 mm in predicting postoperative poor LVEF recovery in patients with ischemic cardiomyopathy (30%≤LVEF≤ 40%) were 74.6% and 47.5%, respectively.n Conclusions:The increased LVEDD and no angina pectoris were independent risk factors for poor LVEF recovery after CABG in patients with ischemic cardiomyopathy (30%≤LVEF≤40%). LVEDD≥60 mm can be used as a predictor of less benefit from preoperative ejection function.