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[主动脉冠状动脉搭桥手术后自行车运动负荷试验前后的左心室功能]

[The left ventricular function in bicycle ergometric stress before and after aortocoronary bypass surgery].

作者信息

Hirzel H O, Wegmüller R, Grimm J, Krayenbühl H P, Senning A

出版信息

Schweiz Med Wochenschr. 1981 Nov 7;111(45):1718-21.

PMID:6975996
Abstract

Biplane left ventricular cineangiograms and pressure measurements were performed in 44 patients with coronary heart disease at rest and during submaximal or symptom-limited supine bicycle exercise before and 7 +/- 3 months after bypass surgery. Revascularization was complete in 12 (group 1) and incomplete in 32 patients (group II). Preoperative left ventricular ejection fraction (EF) was within normal limits at rest and declined during exercise in both groups (group I from 59 to 51%, p less than 0.01; group II from 61 to 48%, p less than 0.001). Postoperative EF at rest was nearly identical to preoperative EF in both groups and remained unchanged during exercise (group I from 65 to 63%; group II from 58 to 56%). Peak systolic pressure to end-systolic volume index ratio (LVSP/ESVI in mm Hg/ml . m-2) also decreased during exercise in both groups peroperatively (group I from 3.7 to 3.2 [n.s.]; group Ii from 3.4 to 2.6, p less than 0.005). Postoperative LVSP/ESVI at rest was again unchanged as compared to preoperative LVSP/ESVI. During exercise, however, it increased in both groups, reaching higher values in group I than in group II (5.1 vs. 3.7, p less than 0.05). Whereas both parameters indicate improvement of global left ventricular function following surgery, LVSP/ESVI also suggests more marked recovery of function in patients with complete revascularization than in those where revascularization is incomplete.

摘要

对44例冠心病患者在搭桥手术前以及术后7±3个月,于静息状态下和次极量或症状限制的仰卧位自行车运动期间进行了双平面左心室心血管造影和压力测量。血运重建完全的有12例(第1组),不完全的有32例(第II组)。术前两组患者静息时左心室射血分数(EF)均在正常范围内,运动期间均下降(第1组从59%降至51%,p<0.01;第II组从61%降至48%,p<0.001)。两组患者术后静息时EF与术前几乎相同,运动期间保持不变(第1组从65%降至63%;第II组从58%降至56%)。两组患者术中运动期间收缩压峰值与收缩末期容积指数之比(LVSP/ESVI,单位为mmHg/ml·m-2)也均下降(第1组从3.7降至3.2[无统计学意义];第II组从3.4降至2.6,p<0.005)。术后静息时LVSP/ESVI与术前相比再次无变化。然而,运动期间两组该比值均升高,第1组高于第II组(5.1对3.7,p<0.05)。虽然这两个参数均表明手术后整体左心室功能有所改善,但LVSP/ESVI也提示血运重建完全的患者比血运重建不完全的患者功能恢复更明显。

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