Hausmann H, Warnecke H, Ennker J, Topp H, Schiessler A, Hempel B, Friedel N, Schmitt D, Hetzer R
Department of Thoracic and Cardiovascular Surgery, German Heart Institute, Berlin.
Cardiovasc Surg. 1993 Oct;1(5):558-62.
A total of 224 patients with angina pectoris and a left ventricular ejection fraction in the range of 10-30% (mean 24.2%) underwent coronary artery bypass grafting between April 1986 and August 1991. These patients received a mean (s.d.) of 2.9 (0.3) aortocoronary vein grafts. The overall operative mortality rate was 8.9%. The 1-, 2- and 3-year survival rates were 87.7%, 86.7% and 85.2%, respectively. Analysis of operative risk factors showed that patients with an end-diastolic left ventricular pressure > 24 mmHg were significantly more at risk (mortality rate 20.0%, P < 0.05) than those with an end-diastolic left ventricular pressure < or = 24 mmHg (mortality rate 6.2%). Patients with a perioperative cardiac index < 2.5 l min-1m-2 had higher mortality (25.4%) than those with a cardiac index > or = 2.5 l min-1m-2 (mortality 1.9%, P < 0.001). The operative mortality rate of patients with a cardiac index < 2.5 l min-1m-2 and an end-diastolic left ventricular pressure > 24 mmHg was 40.5%. Patients with a left ventricular ejection fraction of 10-20% were not significantly more at risk (P > 0.05) than those with a left ventricular ejection fraction of 21-30%.
1986年4月至1991年8月期间，共有224例心绞痛患者接受了冠状动脉搭桥手术，其左心室射血分数在10%至30%之间（平均为24.2%）。这些患者平均接受了2.9（标准差0.3）条主动脉冠状动脉静脉移植血管。总体手术死亡率为8.9%。1年、2年和3年生存率分别为87.7%、86.7%和85.2%。手术风险因素分析表明，舒张末期左心室压力>24 mmHg的患者比舒张末期左心室压力≤24 mmHg的患者风险显著更高（死亡率分别为20.0%和6.2%，P<0.05）。围手术期心脏指数<2.5 l·min⁻¹·m⁻²的患者死亡率更高（25.4%），而心脏指数≥2.5 l·min⁻¹·m⁻²的患者死亡率为1.9%（P<0.001）。心脏指数<2.5 l·min⁻¹·m⁻²且舒张末期左心室压力>24 mmHg的患者手术死亡率为40.5%。左心室射血分数为10%至20%的患者与左心室射血分数为21%至30%的患者相比，风险无显著增加（P>0.05）。
