摘要
目的探讨冠心病合并完全性左束支传导阻滞的外科治疗。方法2002年9月至2007年2月，完成9例冠心病（CAD）合并完全性左束支传导阻滞（CLBBB）病人的冠状动脉旁路移植手术。术前多次心电图均为CLBBB，1例术前放置永久起搏器。体外循环下手术2例，体外循环下心脏不停跳下手术1例，非体外循环下不停跳下手术6例。结果2例体外循环下手术者均死亡，其中1例术中心脏复跳后心率慢，各种方法治疗无效；另1例术后心室率慢，药物及起搏器治疗3 d后无效死亡。7例生存者均为不停跳手术者，术后3 d心率明显增加[（51.2±12.6）次/min到（82.5±23.8）次/min]，其中1例术后随访3个月，多次心电图示CLBBB消失，转复为窦性心律，另6例仍为CLBBB；随访3～36个月均有心功能改善，射血分数（EF）术前0.58±0.17，术后0.63±0.12，心率维持在70～90次/min。结论CAD合并CLBBB行冠状动脉旁路移植手术风险较大，但非手术禁忌证。正确围手术期处理，合理应用临时或永久起搏器，尽可能采用心脏不停跳手术等措施可明显降低手术风险，术后心功能改善，神经功能也有一定恢复。
Objective To investigate the surgical management of coronary artery disease（CAD）patients with completed left hundle hranch block（CLBBB）.Methods Nine patients of CAD associated with CLBBB underwent coronary artery bypass grafts（CABG） from September 2002 to February 2007.All patients were definited CLBBB by repeated ECG.One patient used permanent pacemaker before operation.Two patients underwent CABG by extracorporeal circulation,one patient underwent on pump heart beating CABG,others underwent off pump CABG（OPCAB）. Results Two patients undergoing CABG by extracorporeal circulation dead, the one died of resistant bradycardiac after heart resuccitation, the other one died ofbradycardia 3 days later despite of medication and pacemaker measures. Seven survivors ventricular rate increased significantly 3 days after operative [preoperative HR（51.2±12.6）/min, postoperative HR （82.5 ±23.8）/min], CLBBB disappeared in one patient three months later post-operative and reverted to sinuas rate, but CLBBB in other 6 patients persisted. All survivors had improvement in cardiac function during 3 - 36 months follow-up, preoperative eject factor （EF） was （58.4±17.1）%, postoperative EF was （63.1±11.6）% . Heart rate were maintained 70- 90/min. Conclusion CABG in patients with CLBBB is risky, but it isn＇ t a contraindication. Proper peri-oprative treatment, using temporary or permanent pacemaker rationally and making the most of on-beating CABG technique may decrease operative risk. Cardiac function could improved after operation.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2007年第6期372-373,共2页
Chinese Journal of Thoracic and Cardiovascular Surgery
