同期行冠状动脉旁路移植和心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床研究  

Clinical Study on the Synchronous Cardiac Valve Operation plus Coronary Artery Bypass Grafting in the Treatment of Coronary Heart Disease Combined with Valvular Heart Disease

作　　者：殷恩智 田伟臣[1] 李刚[1] 吕航[1] 李君权[1] 

机构地区：[1]哈尔滨医科大学附属第二医院心血管外科,黑龙江哈尔滨150086

出　　处：《现代生物医学进展》2014年第10期1890-1892,共3页Progress in Modern Biomedicine

摘　　要：目的:总结同期行冠状动脉旁路移植(CABG)和心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床经验。方法:回顾性分析我院收治的41例接受冠状动脉旁路移植同期行心脏瓣膜置换术的冠心病合并心脏瓣膜病患者的临床资料,对手术方法、主要并发症和术后处理方法进行分析总结。结果:41例患者中,行二次开胸4例(9.76%),应用IABP 2例(4.88%),发生低心排综合征6例(14.63%)、肾功能不全6例(14.63%)、肺功能不全7例(17.07%)、脑合并症1例(2.44%)、胸腔积液4例(9.77%),死亡6例(13.63%),其余患者康复出院。结论:CABG同期行心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的近期疗效满意。术前改善心功能,成熟的手术技术,完全的心肌再血管化,良好的心肌保护,停机困难者尽早应用主动脉内球囊反搏(IABP)及加强术后处理是提高CABG同期行心脏瓣膜置换术疗效的重要措施。Objective： To summarize the clinical experience of synchronous Cardiac Valve Operation plus Coronary Artery Bypa- ss Grafting in the treatment of coronary heart disease combined with valvular heart disease. Methods： A retrospective study was carded out to review 41 cases of coronary artery disease combined with valvular heart disease that underwent synchronous CABG plus cardiac valve replacemem. The surgical technique complications and post-operative treatment were analyzed. Results： Early post-operative complication included： re-open in 4 cases（9.76%）, LCOS in 6 cases（14.63%）, IABP used in 2 cases（4.88%）, renal insufficiency in 6 cases （14.63%）, respiratory insufficiency in 7 cases （17.07%）, complication of CNS in 1 case （2.44%）, pleural effusion in 4 eases （9.77%） and death in 6 cases （13.63%）. The others had favorable outcomes. Conclusion： Synchronous CABG combined with cardiac valve replacement showed a good early outcome in the treatment of patients with coronary artery disease combined with valvular heart disease. Preoperative improvement of heart function, perfect surgical technique, complete transmyocardial laser revascularization, effective myocardial protection, early application of IABP on the patients who was difficult to wean from pump could significantly improve the efficacy of CABG combined with cardiac valve replacement in the treatment of coronary heart disease combined with valvular heart disease.

关 键 词：心脏瓣膜病 冠状动脉性心脏病 冠状动脉旁路移植术 瓣膜置换术 

分 类 号：R654.2[医药卫生—外科学] R541.4[医药卫生—临床医学]