同期行冠状动脉旁路移植及心脏瓣膜置换术75例临床分析  

Operation combined cardiac valve replacement and coronary artery bypass grafting:a report of 75 cases

作　　者：陈凯明[1] 钟焕清[1] 陈海生[1] 黄志辉[1] 钟志敏[1] 陈景伟[1] 赖锋华[1] 许发珍[1] 

机构地区：[1]广东省高州市人民医院心外科,广东高州525200

出　　处：《海南医学》2009年第3期1-3,共3页Hainan Medical Journal

摘　　要：目的总结同期施行冠状动脉旁路移植术(CABG)+心瓣膜置换术的术中及围术期处理经验。方法2000年1月至2007年12月共行CABG+心瓣膜置换术75例,共移植血管136支,平均每例移植血管1.81支,其中同期行二尖瓣置换术(MVR)37例,主动脉瓣置换术(AVR)16例,二尖瓣及主动脉瓣双瓣置换术(DVR)22例。结果术后早期死亡5例(6.7%,5/75),死亡原因:低心排引起的急性肾功能衰竭1例及多脏器功能衰竭1例;心室颤动2例;上消化道出血1例。随访64例,随访时间6个月至7年,晚期死亡2例,其余62例心功能明显改善,心绞痛明显减轻或消失。结论CABG联合心瓣膜置换术是治疗冠状动脉粥样硬化性心脏病合并心瓣膜病的有效方法,术中加强心肌保护、尽量缩短心肌缺血时间以及完全的心肌再血管化能有效提高手术成功率。Objective To Sum up the clinical experience of surgical and perioperative treatment of combined cardiac valve replacement and coronary artery bypass grafting（CABG）. Methods From Jan. 2000 to Dec. 2007, operation combined cardiac valve replacement and CABG was performed in 75 patients. All the patients received sternotomy and combined valve replacement and CABG under cardiopulmonary bypass. The total number of grafting vessel were 136, the mean grafting vessel per patient 1.81. Mitral valve replacement, aortic valve replacement, and double valve replacement were performed simultaneously with CABG in 37, 16, and 22 patients, respectively, Results Five patients died postoperatively in short term. 1 patient died of low cardiac output syndrome with multiple organs failure, 1 of low cardiac output syndrome with acute renal failure, 2 of ventricular fibrillation, 2 of upper gastrointestinal hemorrhage. 64 patients had completed follow - up with 2 late non cardiac related death. The follow - up period ranged from 6 months to 7 years. The other 62 patients were discharged from hospital with improved heart function, free of or with significantly decreased angina pectoris. Conclusion Simultaneous cardiac valve replacement and CABG is effective to patients with coronary artery disease and heart valve disease. Excellent myocardial preservation, minimal myocardial ischemia time, and complete myocardial revascularization contribute to the success of operation.

关 键 词：冠状动脉旁路移植术 心瓣膜置换术 同期手术 

分 类 号：R654.2[医药卫生—外科学]