心脏瓣膜手术同期冠状动脉旁路手术治疗冠心病合并瓣膜病的临床观察  

Clinical Study of Combined Cardiac Valve Operation and Coronary Artery Bypass Grafting in Elderly Patients with Coronary Heart Disease and Valvular Disease

作　　者：葛广全[1] 何书武[1] 陈道虎 白敏[1] 王天光[1] 郭义龙[1] 

机构地区：[1]海南农垦总医院心外科,海南海口570311

出　　处：《实用预防医学》2012年第1期96-98,共3页Practical Preventive Medicine

摘　　要：目的探讨心脏瓣膜手术同期冠状动脉旁路手术(CABG)治疗冠心病合并瓣膜病的可行性。方法回顾性分析2005年1月-2011年8月海南农垦总医院行瓣膜手术和CABG的60例患者的临床资料,60例患者按是否同期行心脏瓣膜手术与CABG分为同期组和非同期组,比较两组术后临床指标和随访预后结果。结果同期组术后呼吸机辅助通气时间、ICU室停留时间、术后出院时间均显著低于非同期组,相比较差异有统计学意义(t=12.25、14.89、13.20,P<0.01);同期组术后房颤、围手术期心梗、恶性心律失常的发生率均显著低于非同期组,相比较差异有统计学意义(χ2=6.84、11.40、8.86,P<0.05);随访期内,同期组死亡率、瓣周漏发生率和永久性起搏器植入率均显著低于非同期组,相比较差异有统计学意义(χ2=20.89、7.60、5.07,P<0.05)。结论冠心病合并瓣膜病老年患者同期行CABG与心脏瓣膜手术是可行的。术前和术后要做好对症处理,术中做好心肌保护,可以大大降低手术的死亡率和并发症的发生率。Objective To explore the feasibility of combined cardiac valve operation and coronary artery bypass grafting （CABG） in elderly patients with coronary heart disease and valvular disease. Methods The clinical data of elderly patients with coronary heart disease and valvular disease undergoing surgery in General Hospital of Hainan State Farms from January 2005 to August 2011 were retrospectively analyzed. 60 patients were divided into synchronous surgery group and asynchronous surgery group according to surgical approach, and the results of clinical indicators and follow - up prognosis were compared. Results The postoperative mechanical ventilation time, ICU room stay, postoperative discharge time of the synchronous surgery group were significantly lower than those in the asynchronous surgery group, and the difference was statistically significant between the two groups （t = 12.25, t = 14.89 and t = 13.20, P 〈 0.01 ）. The incidence rates of atrial fibrillation, perioperative myocardial infarction and malignant arrhythmia of the synchronous surgery group were significantly lower than those of the asynchronous surgery group, and the difference was statistically significant between the two groups （X2 = 6.84, Z2 = 11.40 and 7.2 = 8.86, P〈 0.05）. The incidence rates of death, periprosthetic leakage and permanent pacemaker implantation of the synchronous surgery group were significantly lower than those of the asynchronous surgery group, and the difference was statistically significant between the two groups （X2 = 20.89, Z2 = 7.60, X2 = 5.07, P 〈 0.05）. Conclusions The combined cardiac valve operation and CABG in elderly patients with coronary heart disease and valvular disease is feasible. The preoperative and postoperative symptomatic treatment and intraoperative myocardial protection should be well prepared, and these measures can greatly reduce the surgical mortality and the incidence of complications.

关 键 词：冠状动脉旁路移植术 心脏瓣膜手术 同期手术治疗 

分 类 号：R541.4[医药卫生—心血管疾病]