中重度缺血性二尖瓣关闭不全的外科治疗  

Surgical treatment of moderate to severe ischemic mitral regurgitation

作　　者：段亮[1] 肖明第[1] 杨迪成[1] 林雷[1] 毛建强[1] 胡振雷[1] 

机构地区：[1]上海交通大学附属第一人民医院心血管外科

出　　处：《上海医学》2008年第3期155-157,共3页Shanghai Medical Journal

摘　　要：目的探讨冠状动脉旁路移植术(CABG)联合二尖瓣置换术治疗中重度缺血性二尖瓣关闭不全(IMR)的疗效。方法1997年5月—2006年2月共行CABG联合二尖瓣置换术治疗中重度IMR患者18例,均有心肌梗死史,纽约心脏学会(NYHA)心功能分级Ⅱ级7例,Ⅲ级7例,Ⅳ级4例。左心室射血分数(LVEF)为22%～65%,平均为(46±12)%,二尖瓣中度反流5例,中重度9例,重度4例。结果术后早期左心室舒张末内径(LVEDD)为(54.2±11.8)mm,左心房舒张末内径(LAEDD)为(38.1±5.5)mm,均较术前的(63.7±13.0)和(45.4±5.8)mm显著下降(P值均<0.05),LVEF为(48±14)%,与术前(46±12)%的差异无统计学意义(P>0.05)。术后8例出现并发症,严重室性心律失常2例,切口感染行清创缝合术1例,胸腔积液1例,因呼吸功能不全行二次插管1例;另3例术后早期死亡,其中低心排血量综合征术中不能停机死亡1例,术后低心排血量综合征引起急性肾功能衰竭1例,神经系统并发症1例。存活的15例患者随访3～68个月,无抗凝和机械瓣膜引起的并发症,除1例因心力衰竭(NYHA心功能分级Ⅲ级)再次入院接受药物治疗外,其余患者心绞痛及心力衰竭症状明显缓解,NYHA心功能分级均为Ⅰ～Ⅱ级。结论CABG联合二尖瓣置换术是治疗中重度IMR的有效方法。Objective To review our experience on surgical treatment of moderate to severe ischemic mitral regurgitation （IMR） by coronary artery bypass grafting （CABG） combined with mitral valve replacement （MVR）. Methods From May, 1997 to February, 2006, 18 patients with moderate to severe IMR （including 12 male and 6 female patients with a mean age of 67 years） underwent CABG combined with MVR. With the mean left ventricular ejection fraction （LVEF） of （46± 12）%, ranging from 22% to 65%, all the patients had myocardial infarction history, including 7 with cardiac function of class Ⅱ （NYHA）, 7 of class Ⅲ and 4 of class Ⅳ Before the operation, 5 patients were diagnosed as having moderate mitral regurgitation, 9 had moderate to severe mitral regurgitation and 4 had severe mitral regurgitation. Results Both the left ventricular end-diastolic diameter （LVEDD, [54.2±11.8] mm） and left atrial end-diastolic diameter （LAEDD, [38.1±5.5] mm） were significantly decreased early after the operation as compared with those before operation （P〈0.05）. The postoperative LVEF was （48 ± 14）%, showing no significant difference from that before operation （P〉 0. 05）. Eight patients developed complications after the operation, including severe ventricular arrhythmia in 2 patients, incision infection in 1, pleural effusion in 1, and respiratory failure in 1. Death early after the operation occurred in 3 cases due to low cardiac output, acute renal failure, and nervous system complications. The 15 patients who survived the operation were followed up for 3 - 68 months, during which no death or complications resulting from anticoagulation therapy or the mechanical valve occurred. Except for one patient with cardiac function deficit （NYHA class Ⅲ ） who was admitted again for medical treatment, all the other patients had cardiac functions of NYHA classⅠ - Ⅱ . Conclusion CABG combined with MVR is effective for treatment of moderate to severe IMR.

关 键 词：二尖瓣关闭不全 缺血 外科治疗 

分 类 号：R654.2[医药卫生—外科学] R722.12[医药卫生—临床医学]