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[心肌血运重建术后短时间内的左心室功能:放射性核素血管造影研究]

[Left ventricular function a short time after myocardial revascularization surgery: radioisotope angiographic study].

作者信息

Astorri E, Contini G A, Busi M, Calbiani B, Fesani F

出版信息

Cardiologia. 1989 Nov;34(11):945-52.

PMID:2631987
Abstract

The short-term effects after coronary bypass surgery on left ventricular function were studied in 65 patients with coronary artery disease. Each patient underwent gated radionuclide left ventriculography on the second-third day before and 5-7 days after coronary bypass surgery. After surgery, global ventricular ejection fraction had a significant increase, anteroseptal wall motion was unchanged, while apical motion and mainly inferoposterior motion were significantly increased. The most important improvement of inferoposterior motion was observed in 18 patients who had complete revascularization of the previously infarcted inferior segments, while in the 11 patients with incomplete revascularization of the same area, inferoposterior motion had a slight increase. There was a slightly significant direct linear correlation between size and direction of the anteroseptal and inferoposterior motion changes. The patients were divided in subgroups related to the site and number of obstructed coronary vessels as well as of implanted grafts; the computed parameters showed similar changes in all subgroups. After surgery, peak ejection rate showed an evident increase, and time to peak reciprocally shortened. Peak filling rate, which had reduced preoperative values, was found clearly improved, with a corresponding shortening of the time to peak; these results confirmed that diastolic ventricular damage was a reversible disturbance related to myocardial ischemia. In 8 of the 65 patients, 24 hours urinary catecholamine levels showed similar values at both pre and postoperative radionuclide controls. In conclusion, the radionuclide angiography showed an evident improvement of left ventricular function during a short period following surgery, suggesting a better myocardial perfusion after revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

对65例冠心病患者进行了冠状动脉搭桥手术后左心室功能短期影响的研究。每位患者在冠状动脉搭桥手术前第二至三天和术后5至7天接受门控放射性核素左心室造影。术后,整体心室射血分数显著增加,前间隔壁运动未改变,而心尖运动及主要是下后壁运动显著增加。在先前梗死的下壁节段实现完全血运重建的18例患者中观察到下后壁运动的最重要改善,而在同一区域血运重建不完全的11例患者中,下后壁运动略有增加。前间隔和下后壁运动变化的大小和方向之间存在轻微显著的直接线性相关性。根据阻塞冠状动脉血管的部位和数量以及植入移植物的情况将患者分为亚组;计算参数在所有亚组中显示出相似的变化。术后,射血峰值速率明显增加,达到峰值的时间相应缩短。术前值降低的峰值充盈率明显改善,达到峰值的时间相应缩短;这些结果证实舒张期心室损害是与心肌缺血相关的可逆性紊乱。在65例患者中的8例中,24小时尿儿茶酚胺水平在术前和术后放射性核素对照时显示相似值。总之,放射性核素血管造影显示术后短期内左心室功能明显改善,提示血运重建后心肌灌注更好。(摘要截断于250字)

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