摘要
目的:探讨左心室减容术(partialleftventriculectomy,PLV)治疗难治性心力衰竭的方法。方法:11例晚期难治性心力衰竭患者,包括晚期瓣膜性心肌病6例、扩张性心肌病4例、缺血性心肌病1例,均行PLV,同期行双瓣膜置换6例,冠状动脉移植术1例。结果:患者无手术死亡,术后早期心脏功能、左心室形态及血流动力学参数明显改善,临床症状缓解。心率由(104.00±20.16)次/min降至(82.55±10.41)次/min(r=0.662,P=0.027),心功能(3.36±0.31)级降至(1.55±0.52)级(r=0.690,P=0.019)。心胸比由0.79±0.04降至0.58±0.05(r=0.720,P=0.013),左心室舒张末期直径由(79.29±2.68)mm降至(54.02±1.69)mm(r=0.649,P=0.031),左心室收缩末期直径由(63.35±4.85)mm降至(29.59±4.60)mm(r=0.611,P=0.046)。左心室射血分数由0.23±0.04增至0.540±0.08(r=0.623,P=0.041),心输出量由(2.68±0.57)L/min增至(4.39±0.54)L/min(r=0.765,P=0.006),平均动脉压由(78.18±6.55)mmHg增至(90.36±4.57)mmHg(r=0.863,P=0.001),静脉血氧饱和度由0.38±0.03增至0.69±0.05(r=0.535,P=0.090),中心静脉压由(14.00±2.28)cmH20降至(9.45±1.37)cmH20(r=0.609,P=0.047),平均肺动脉压由(29.09±5.49)mmHg降至(18.91±3.99)mmHg(r=0.703,P=0.016),平均肺动?
Objective: To investigate portial left ventriculectomy to treat end-stage heart disease. Methods: From April 2000 to July 2003, eleven patients \[7 men, 4 women; mean age (45.27±(9.67)) years\] underwent partial left ventriculectomy. The underlying disease was valvular disease in 6 patients, idiopathic dilated cardiomyopathy in 4 patients and ischemic in one patient. Functional class graded New York Heart Association (NYHA) was 3.36±0.31, 3 patients depended on inotropic support. Mean ejection fraction (EF), cardiac output (CO), left ventricular end-diastolic diameter (LVEDD), venous oxygen partial pressure (SvO_(2)) and cardiothorac ratio (CTR) were analyzed. Coronary bypass(1 patient), aortic and mitral valve replacement(6 patients), and IABP device implantation(2 patients) were performed. Results: Mean EF, CO, and SvO_(2) rose significantly(P<0.05). Mean LVEDD and CTR decreased significantly(P<0.05). Functional class of NYHA was 1.55±(0.52.) Conclusion: Partial left ventriculectomy improves objective and subjective parameters of cardiac performance significantly in early and short-term follow-up.
出处
《医学研究生学报》
CAS
2005年第6期512-515,共4页
Journal of Medical Postgraduates
基金
南京军区南京总医院重点课题基金资助项目(批准号:2003086)
关键词
左心室减容术
心室重构
心力衰竭
终末期心脏病
Partial left ventriculectomy
Ventricular remodeling
Heart failure
End-stage heart disease
