冠状动脉旁路移植并同期心脏瓣膜的手术治疗  

Experience of valves operation in patients with coronary artery bypass grafting

作　　者：王宏山[1] 戴仕林[1] 申红亚[1] 李明[1] 

机构地区：[1]郑州大学第二附属医院心血管外科,郑州450003

出　　处：《临床医学》2011年第7期1-2,共2页Clinical Medicine

摘　　要：目的总结同期实施冠状动脉旁路移植与心脏瓣膜手术的治疗效果和临床经验。方法 2004年5月至2010年10月同期行冠状动脉旁路移植和心脏瓣膜手术49例,其中冠心病合并心脏瓣膜病变14例,风湿性心脏病合并冠状动脉病变35例,合并左心房血栓5例。行单纯二尖瓣置换术26例,单纯主动脉瓣置换11例,双瓣膜置换10例,二尖瓣成形2例;移植旁路血管99支,平均2.02支。结果无手术死亡病例,术后再次开胸止血1例;发生低心排出量2例,肺不张1例,心包积液3例。49例患者心脏功能明显改善,临床治愈出院;术后随访3～24个月,1例生物瓣置换术后半年再次出现左房血栓,无死亡事件,患者生活质量明显改善。结论同期行冠状动脉旁路移植和心脏瓣膜手术是一种安全、有效的治疗方法。Objective To summarize the clinical experience of valves operation in patients with coronary artery bypass grafting.Methods We retrospectively analyzed the clinical datas of 49 patients who were treated by valves operation and coronary artery bypass grafting,and 14 patients with coronary heart disease combined with valvular heart disease;35 patients with rheumatic heart disease combined with pathological changes in coronary artery;and another 5 patients combined with thrombus in left atrium.There were 26 patients replaced their mitral valves,and 11 patients replaced their aortic valves,other 10 patients done operation of double-valve replacement.There were 2 patients accepted the operations of mitral valves repair.There were 99 blood vessels for transplantation,and 2.02 on average.Results All patients were alive,only one patient returned to operation room for stopping bleeding.There were 2 patients underwent low cardiac output after operation;one patient of pulmonary atelectasis,3 patients of pericardial effusion.The cardiac function of 49 patients were improved.The follow-up study continued from 3 to 24 months after operation,which showed one case who replaced a bioprosthetic valve appeared thrombus in left atrium half one year later.Conclusion It is a safe and effective therapeutic method to treat the patients underwent valves operation combined with coronary artery bypass grafting.

关 键 词：冠心病 心脏瓣膜病 心脏瓣膜手术 冠状动脉旁路移植 

分 类 号：R654.2[医药卫生—外科学]