冠心病合并室壁瘤及瓣膜病变的同期手术治疗  

Concurrent Procedures in Surgical Treatment of Coronary Heart Disease Combined with Left Ventricular Aneurysm and Valvular Lesions

作　　者：任伟[1] 王志维[1] 夏军[1] 邓宏平[1] 吴智勇[1] 徐鹏[1] 李罗成[1] 周桢[1] 

机构地区：[1]武汉大学人民医院心血管外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2014年第2期264-267,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨同期处理室壁瘤和瓣膜病变在冠心病外科治疗中的临床经验和手术效果。方法:对95例冠心病合并室壁瘤或(和)瓣膜病变患者在体外循环下同期实施冠状动脉旁路移植术、左室成形术及瓣膜置换(成形)术,比较术前、术后早期及晚期心功能。32例室壁瘤均采用Dor术治疗,二尖瓣成形术8例,二尖瓣置换术46例,主动脉瓣替换术16例,三尖瓣成形术18例,移植旁路血管2-4支/例。结果:全组手术后围术期死亡2例(2.1%),死于低心排综合征1例,多器官功能衰竭1例,其他93例患者痊愈出院。术后随访86例,随访(50.6±19.2)月,死亡2例,失访7例。心功能NYHA分级从术前(3.05±0.55)级改善到术后早期(1.73±0.65)级、远期(1.61±0.67)级;左室射血分数(LVEF)从术前(46.75±8.32)%提高到术后早期(55.09±6.72)%、远期(55.86±6.94)%。左室舒张末内径(LVEDD)由术前(60.53±8.14)mm减小至术后早期(52.79±6.61)mm、远期(54.37±6.23)mm,以上比较均为P<0.05,有统计学差异。结论:对左心室腔、冠脉血管及瓣膜病变的同期干预能较好的改善心功能,近远期疗效显著,是冠心病合并室壁瘤及瓣膜病变外科治疗中非常有效的方法。Objective： To investigate the clinical outcome after surgical treatment of coronary artery disease （CAD） with concomitant managements of CAD associated left ventricular aneurysm and valvular lesions. Methods： After the diagnosis of CAD and combined ventricular aneurysm or valvular disease, 95 consecutive patients underwent coronary artery bypass graft （CABG） under cardiopulmonary bypass （CPB）. The concomitant procedures included 32 cases of Dor procedure, 10 mitral valve replacement, 8 mitral valvuloplasty, 16 aortic valve replacement, and 18 tricuspid valve repair. Numbers of graft applied ranged from 2 to 4. A comparison of cardiac function was performed between preoperative, early postoperative and long-term postoperative periods. Results： Overall peri-operative mortality was 2.1%, the cause was low cardiac output syndrome in one patient and multiple organ failure in another. The remaining 93 patients recovered and discharged uneventfully, and 86 patients were followed up for a mean duration of （50.64±19.2） months. The NYHA class improved from （3.05±0.55） before operation to （1.73±0.65） and （1.61±0.67） in early and longtime postoperative periods, respectively. The preoperative LVEF was （46.75±8.32）% and improved to （55.09±6.72）% in early stage and （55. 86±6.94）% in long-term postoperative period respectively, while LVEDD decreased from （60.53±8.14） mm to （52.79±6.61） mm and （54.37±6.23） mm respectively. All the statistical test was proved to be signilicant with a p-value〈O.05. Conclusion：For the patients with CAD associated left ventrmular aneurysm and valvular lesions, concomitant managements were effective to improve the heart function.

关 键 词：同期手术 冠心病 室壁瘤 瓣膜病 

分 类 号：R543.3[医药卫生—心血管疾病]