王建,赖可可,张哲义,苏茂龙,王焱

• 1:厦门大学附属心血管病医院心内科
• 2:厦门大学附属中山医院放射科

摘要(Abstract)：

目的评价经皮左心室重建术对心尖部室壁瘤形成的缺血性心肌病患者术后即刻心排量的影响。方法纳入2015年1月至2016年12月于厦门大学附属心血管病医院行经皮左心室重建术的心尖部室壁瘤形成的缺血性心肌病患者25例。监测患者在经皮左心室重建术前、后的心功能指标变化情况。结果 25例患者中男23例(92.0%),平均年龄(65.4±11.9)岁,体重指数(23.2±4.0)kg/m2。共24例(96.0%)患者成功进行经皮左心室重建术,1例因装置无法达到最佳位置而终止手术。PARACHUTE装置植入后,患者心排量[(4.85±0.93)L/min比(3.83±0.72)L/min,P<0.01]、心排量指数[(2.90±0.82)L/(min·m~2)比(2.32±0.74)L/(min·m~2),P<0.01]均显著高于开伞前,差异均有统计学意义。复苏后患者的心功能仍保持稳定,心排量[(5.01±0.92)L/min比(3.83±0.72)L/min,P<0.01]、心排量指数[(3.01±0.87)L/(min·m~2)比(2.32±0.74)L/(min·m~2),P<0.01]均较术前显著增加,差异均有统计学意义。结论经皮左心室重建术后即刻明显提高心尖部室壁瘤形成的缺血性心肌病患者的心排量和心排量指数,这可能与植入物即刻改善心尖部室壁瘤的矛盾运动相关。

关键词(KeyWords)： 经皮左心室重建术;缺血性心肌病;心尖部室壁瘤

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王建,赖可可,张哲义,苏茂龙,王焱

参考文献(References)：

• [1]Krum H,Teerlink JR.Medical therapy for chronic heart failure.Lancet,2011,378(9792):713-721.
• [2]Schinkel AF,Poldermans D,Rizzello V,et al.Why do patients with ischemic cardiomyopathy and a substantial amount of viable myocardium not always recover in function after revascularization?J Thorac Cardiovasc Surg,2004,127(2):385-390.
• [3]Mills NL,Everson CT,Hockmuth DR.Technical advances in the treatment of left ventricular aneurysm.Ann Thorac Surg,1993,55(3):792-800.
• [4]Host NB,Hansen PR.Infarction expansion and ventricular remodelling after acute myocardial infarction.Ugeskr Laeger,1993,155(43):3463-3467.
• [5]Asinger RW,Herzog CA,Dick CD.Echocardiography in the evaluation of cardiac sources of emboli:the role of transthoracic echocardiography.Echocardiography,1993,10(4):373-396.
• [6]王建,王斌,肖国胜,等.经皮左心室分隔术对心尖部室壁瘤形成的缺血性心力衰竭患者的安全性及疗效评估.中国循环杂志,2016,31(8):775-779.
• [7]李桂阳,王建,苏茂龙,等.左室室壁瘤分区术治疗缺血性心力衰竭并室壁瘤.中国分子心脏病学杂志,2016,17(3):1718-1720.
• [8]Thomas M,Nienaber CA,Ince H,et al.Percutaneous ventricular restoration(PVR)therapy using the Parachute device in 100 subjects with ischaemic dilated heart failure:one-year primary endpoint results of PARACHUTE III,a European trial.Euro Intervention,2015,11(6):710-717.
• [9]Bruschke AV,Proudfit WL,Sones FM Jr.Progress study of 590consecutive nonsurgical cases of coronary disease followed 5-9years.II.Ventriculographic and other correlations.Circulation,1973,47(6):1154-1163.
• [10]Jones RH,Velazquez EJ,Michler RE,et al.Coronary bypass surgery with or without surgical ventricular reconstruction.N Engl J Med,2009,360(17):1705-1717.
• [11]王焱,王斌,常贺,等.厦门市心血管病医院构建区域协同胸痛急救网络探索.中华医院管理杂志,2016,32(6):453-455.
• [12]Dai SM,Zhang S,Chen KP,et al.Prognostic factors affecting the all-cause death and sudden cardiac death rates of post myocardial infarction patients with low left ventricular ejection fraction.Chin Med J(Engl),2009,122(7):802-806.
• [13]Silva G,Melica B,Pires de Morais G,et al.Percutaneous implantation of a ventricular partitioning device for treatment of ischemic heart failure:initial experience of a center.Rev Port Cardiol,2012,31(12):795-801.
• [14]Costa MA,Mazzaferri EL Jr,Sievert H,et al.Percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure:three-year outcomes of the PARACHUTE first-in-human study.Circ Heart Fail,2014,7(5):752-758.
• [15]Costa MA,Pencina M,Nikolic S,et al.The PARACHUTEⅣtrial design and rationale:percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles.Am Heart J,2013,165(4)531-536.
• [16]Baxley WA,Jones WB,Dodge HT.Left ventricular anatomical and functional abnormalities in chronic post infarction heart failure.Ann Intern Med,1971,74(4):499-508.
• [17]吕昀,曾亚莉,郭晔炳,等.不同血运重建方法对陈旧前壁心肌梗死合并左心室室壁瘤患者预后的影响.中国介入心脏病学杂志,2015,23(4):203-207.
• [18]申磊磊,汪成,王嵘,等.左心室室壁瘤患者行左室成形术与单纯冠脉旁路移植术的中远期疗效对比.南方医科大学学报,2016,35(5):681-687.