冠状动脉搭桥联合瓣膜置换术的临床处理  

Clinical management of coronary artery bypass grafting combined with valve replacement

作　　者：毛建强[1] 肖明第[1] 刘延华[1] 袁忠祥[1] 卢成宝[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,200080

出　　处：《上海医学》2008年第11期796-798,共3页Shanghai Medical Journal

摘　　要：目的总结冠状动脉搭桥(CABG)联合瓣膜置换术的临床处理经验,提高治疗效果。方法1998年12月—至2007年4月共施行CABG联合瓣膜置换术96例,男64例,女32例,年龄41～82岁,平均年龄为(66±9)岁。36例有风湿性心脏病史,27例有心肌梗死病史,其中7例合并室壁瘤。单纯左房室瓣病变66例,主动脉瓣病变19例,左房室瓣合并主动脉瓣病变11例。冠状动脉造影检查示,多支病变36例,两支病变30例,单支病变30例。术前左心室射血分数为0.14～0.79,平均为0.53±0.15,纽约心脏病学会心功能分级Ⅱ级43例,Ⅲ级42例,Ⅳ级11例。本组共搭桥192支,其中左胸廓内动脉50支,平均2支/人,行左房室瓣置换+CABG66例,主动脉瓣置换+CABG19例,左房室瓣联合主动脉瓣置换+CABG11例,同期处理室壁瘤7例。结果全组死亡17例,病死率为17.7%,其中死于低心脏排血量综合征10例,多脏器衰竭3例,恶性心律失常2例,肾功能衰竭2例。术后随访3～18个月,均无心绞痛发作,心功能得到改善。结论CABG联合瓣膜置换术风险较大,围术期处理十分重要,术中应注意心肌保护和完全心肌血运重建,高龄患者仍可取得较为满意的疗效。Objective To summarize the clinical experience on coronary artery bypass grafting（CABG） combined with cardiac valve replacement, so as to improve the results of treatments. Methods From December 1998 to April 2007, 96 patients（64 men, 32 women） underwent combined CABG and cardiac valve surgery. The mean age of the patients was （66 ± 9） years （ranging 41- 82）. Thirty-six patients bad a history of rheumatic heart disease and 27 had a history myocardial infarction, including 7 with ventricular aneurysms. There were 66 cases with pure mitral valves lesion, 19 with aortic valves lesion, and 11 with mitral valve and aortic valve lesion. Multi-vessel involvement was found in 36 patients, two-vessel involvement in 30 and single vessel involvement in 30 according to the cardioangiography （CAG）. Heart function was Class Ⅱ （NYHA） in 43 patients, Class Ⅲ in 42, and Class Ⅳ in 11. The total number of grafts was 192 （2/patient）, including 50 left internal mammary artery （LIMA）. Mitral valve replacement （MVR） and CABG were done in 66 patients; aortic valve replacement （AVR） and CABG were done in 19 patients. MVR, AVR and CABG were done in 11 patients. Seven patients had ventricular aneurysm resection concomitantly. Results Seventeen patients died in our group with a mortality of 17.7%, including 10 died of low cardiac output syndrome,3 died of multiorgan failure, 2 died of malignant arrhythmia and 2 died of renal failure. The patients were followed up for 3 to 18 months; there was no angina and the cardiac function was improved. Conclusion CABG combined with cardiac valve surgery has high risks. The perioperative managements are very important. Myocardial preservation and complete revascu-larization should be emphasized during the surgery. Elderly patients can also have satisfactory treatment outcomes.

关 键 词：冠状动脉搭桥 瓣膜置换 心功能 

分 类 号：R654.2[医药卫生—外科学] R714.21[医药卫生—临床医学]