摘要
目的分析心脏瓣膜替换或成型术同时行冠状动脉旁路移植术的临床特点。方法278例手术共移植旁路血管392支,同时行主动脉瓣置换手术136例,二尖瓣置换141例,二尖瓣成型63例,三尖瓣成型44例。瓣膜病合并冠心病的冠状动脉受累以单支受累最多,为123例,双支次之,为102例,多支血管受累53例。单支受累以前降支及右冠状动脉多见,回旋支次之。围术期注意心肌保护和心肌缺血预防与处理。结果换瓣搭桥术中主动脉阻断时间(96±21)min。围术期死亡18例(8.7%)。围术期发生主要脏器并发症比例17.0%。术后ICU监护1.7 d,术后住院时间平均9.7 d。术前左心室舒张末期内径(54.7±9.2)mm,左心室收缩末期内径(38.2±10.6)mm,左心室射血分数32%～65%。手术后左心室舒张末期内径(51.3±7.1)mm,左心室收缩末期内径(36.4±10.6)mm。Logistic Regression多因素统计分析显示年龄、高血压、术前NYHA心功能分级与手术病死率相关。结论心脏瓣膜手术同时行冠状动脉旁路移植术的危险性高于单一手术,彻底解除瓣膜病变、充分的心肌再血管化和良好的心肌保护是手术成功的主要因素。
Objective To analyze the clinical characteristics of coronary artery bypass grafting （CABG） combined with concomitant valve operation. Methods 278 cases of coronary artery disease with valve diseases underwent myocardial revascularization surgery combined with concomitant valve operation. Totally 392 bypass vessels were performed and aortic vane replace in 136 cases ,mitral valve replace in 141 cases ,mitral repair in 63 cases and tricuspid repair in 44 cases. Unique coronary stenosis was found in 123 cases and double vessel diseases were found in 102 cases,and multiple vessel diseases were found in 53 cases. The unique vessel disease was usually seen in LAD, RCA and LCX. During the perioperative periods more attention should be paid to the myocardial protection and myocardial ischemic prevention. Results The mean cross clamp time was （ 96 ± 21 ）mins. The perioperative mortality was 8.7% and the main organs complication rate was 17.0%. The ICU stay time was 1.7 days and the patients were discharged 9.7 days areragelly after operation. The left ventricle end-dilate and systolic diameter were （51.3 ± 7.1 ）mm and （ 36.4 ± 10.6 ） mm individually While which was （ 54.7 ± 9.2 ） mm and （ 38.2 ± 10.6 ） mm before surgery. Logistic regression risky statistics results showed the age,angina pectoris history,hypertension history and cardiac NYHA function were the mortality related multiple-risk factors. Conclusion CABG combined with valve surgery is more complicated than the valve or coronary bypass surgery alone. To resolve the valve disease completely,full revascularization strategy and good myocardial protection are the key points to get good surgery results.
出处
《中国综合临床》
北大核心
2007年第12期1097-1099,共3页
Clinical Medicine of China
