RT-3DE评价非体外循环冠状动脉搭桥术对左心房功能的影响

Evaluation of the effects of off-pump coronary artery bypass grafting on left atrial function with RT-3D echocardiography

关键词:  实时三维超声心动图  非体外循环冠状动脉搭桥术  舒张功能  左心房功能

Key words:  real-time three-dimensional echocardiography  off-pump coronary artery bypass grafting  diastolic fuction  left atrial function

摘要:

目的 应用RT-3DE评价非体外循环冠状动脉搭桥（OPCABG）术后早期及中期对左心房功能的影响。方法 选取70例接受OPCABG手术的冠心病患者作为OPCABG观察组，分别于术前、术后1个月及术后6个月测量其左心室舒张功能相关参数（LAD、E/A、E/e’）、左心房容积相关参数（LAVmax、LAVmin、LAVp）以及左心房射血分数（LAPEF、LAAEF）。另外选取年龄匹配的30例正常人群作为健康对照组。比较OPCABG观察组各个不同时期与对照组之间各项指标间的差异，并对OPCABG观察组左心房容积变化率与△E/e’间进行相关性分析。结果 观察组OPCABG患者术前LAD、E/e’与对照组比较显著升高（P<0.05），术后较术前明显降低（P<0.05）；观察组OPCABG患者手术前、后LAAEF与对照组相比无统计学差异（P>0.05）；观察组OPCABG患者手术前LAPEF较对照组下降（P<0.05），术后6个月LAPEF与对照组相比无统计学差异（P>0.05）；LAVmax、LAVmin、LAVp在术前显著增高（P<0.05），OPCABG术后（1个月、6个月）显著下降（P<0.05），观察组OPCABG患者术后6个月的LAVmax、LAVmin及LAVp变化率与△E/e’均呈正相关（r=0.718、0.751、0.601，P<0.01），其中LAVmin变化率与△E/e’的相关性最好。结论 OPCABG术后早期及中期冠心病患者左心房功能及左室舒张功能得到显著改善，左心房功能可以作为评价OPCABG手术疗效的重要指标。

Abstract:

Objective To assess the effects in the early and intermediate term after OPCABG on left atrial function with RT-3DE. Methods Totally 70 patients with multi-vessel coronary artery disease who underwent OPCABG were enrolled as OPCABG group. Another 30 healthy age-matched controls were also enrolled. Conventional echocardiography and RT-3DE images were obtained from the patients and controls before OPCABG, 1 month and 6 months after OPCABG respectively. The parameters of echocardiography were measured. Results LAD and E/e' increased significantly in patients before OPCABG compared to the controls (P<0.05), and decreased significantly in the early and intermediate term after OPCABG (P<0.05). The difference of LAAEF between the three OPCABG groups and the controls was not statistically significant (P>0.05). Compared to the controls, LAPEF decreased, meanwhile, LAVmax, LAVmin and LAVp increased in patients before OPCABG (P<0.05). LAPEF increased, LAVmax, LAVmin and LAVp decreased in the early and intermediate term after OPCABG respectively (P<0.05). In addition, the variation rate of LAVmax, LAVmin and LAVp in patients before OPCABG and 6 months after OPCABG were positively correlated with △E/e'(r=0.718, 0.751 and 0.601, P<0.01). The variation rate of LAVmin has the optimal correlation with △E/e'. Conclusions The left atrial function and left ventricular diastolic function are improved in varying degrees in the early and intermediate term after OPCABG with RT-3DE.