Roberts A J, Spies S M, Sanders J H, Moran J M, Wilkinson C J, Lichtenthal P R, White R L, Michaelis L L
J Thorac Cardiovasc Surg. 1981 Jan;81(1):69-84.
Forty patients who recently underwent coronary artery bypass graft (CABG) operations had serial hemodynamic and scintigraphic studies. Multidose hypothermic potassium crystalloid cardioplegia was used for myocardial protection and newer techniques in anesthetic management and perioperative patient care were also employed. The method of equilibrium cardiac gated blood pool (GBP) scintigraphy was used to obtain perioperative changes in global ejection fraction (EF) and regional wall motion (RWM). Ninety percent of patients displayed a decrease in EF 2 hours postoperatively when compared to their preoperative values. This change was also associated with a fall in cardiac index (CI) and left ventricular stroke work index (LVSWI). Twenty-four hours postoperatively, EF and CI recovered to preoperative levels, but LVSWI remained depressed. Seven days postoperatively, global EF had improved to a value greater than the preoperative one (50% +/- 3% versus 57% +/- 4%, p < 0.05). Perioperative changes in RWM followed the same pattern as EF, but recovery in this index of regional contractility was faster than EF, since maximal improvement was observed 24 hours postoperatively. Thus transient left ventricular dysfunction is common immediately after CABG, but recent advances in myocardial protection and perioperative management are associated with short-term increases in regional and global left ventricular function documented by noninvasive GBP imaging.
40例近期接受冠状动脉旁路移植术（CABG）的患者接受了系列血流动力学和闪烁扫描研究。采用多剂量低温钾晶体心脏停搏液进行心肌保护，并采用了麻醉管理和围手术期患者护理的新技术。采用平衡心脏门控血池（GBP）闪烁扫描法获取围手术期整体射血分数（EF）和局部室壁运动（RWM）的变化。与术前值相比，90%的患者术后2小时EF降低。这种变化还与心脏指数（CI）和左心室每搏功指数（LVSWI）下降有关。术后24小时，EF和CI恢复到术前水平，但LVSWI仍较低。术后7天，整体EF改善至高于术前值（50%±3%对57%±4%，p<0.05）。RWM的围手术期变化与EF遵循相同模式，但该局部收缩性指标的恢复比EF更快，因为术后24小时观察到最大改善。因此，CABG术后立即出现短暂性左心室功能障碍很常见，但心肌保护和围手术期管理的最新进展与通过无创GBP成像记录的局部和整体左心室功能的短期改善有关。
