一站式杂交手术在老年人复杂性心脏病中的应用  

One-stop hybrid cardiac surgery for elderly patients with complex heart disease

作　　者：滕志华[1] 董爱强[2] 孔敏坚[2] 程海峰[2] 蒋峻[2] 

机构地区：[1]义乌市中心医院心胸外科,浙江省义乌322000 [2]浙江大学医学院附属第二医院心脏大血管外科

出　　处：《中国基层医药》2015年第9期1342-1344,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 应用一站式“杂交”手术治疗老年人复杂性心脏病,评价其可行性和安全性.方法 2013年11月至2014年3月共有5例老年复杂性心脏病患者接受一站式“杂交”手术治疗,其中男性4例,女性1例,年龄71 ～78岁,合并COPD 3例,糖尿病2例,高血压3例,心脏瓣膜病变3例,动脉导管未闭1例,冠脉多支病变4例.手术在一站式“杂交”手术室进行,通过右胸小切口施行心脏手术（不停跳前降支旁路移植或瓣膜置换或瓣膜成形）,同期对左主干病变和/或其他非前降支病变行经皮冠状动脉介入治或动脉导管（PDA）未闭封堵术.结果 5例患者均顺利进行一站式“杂交手术”,外科手术时间（125±28） min,介入手术时间（65±33） min,体外循环时间（60±23） min,主动脉阻断时间（42±18） min,术后造影桥血管通畅、支架内通畅.术后机械通气时间为（20.5±6.5）h、术后ICU治疗时间为（68.9±16.6）h、术后住院时间为（9.8±3.7）d.术后无严重并发症发生.随访1～5个月,均无胸闷胸痛症状,无出血及栓塞事件,无心血管不良事件发生,心脏超声检查瓣膜情况良好,PDA无再通.瓣膜手术患者抗凝达标.结论 一站式“杂交”手术治疗老年人复杂性心脏病能减少手术复杂性,降低手术风险,安全可行.Objective To evaluate the efficacy and security of one-stop hybrid cardiac surgery for the treatment of elderly patients with complex heart disease.Methods From November 2013 to March 2014,a total of 5 patients[4 male,age：71-78years] underwent one-stop hybrid approach in the hybrid operating room with chronic obstructive pulmonary disease （COPD） in 3 cases,2 cases of diabetes,3 cases of hypertension,valvular heart disease in 3 cases,PDA in 1 case,4 patients with multivessel coronary disease.Right minimally invasive cardiac surgery（coronary artery bypass grafting or valvular surgery） and percutaneous intervention were performed in an enhanced operative unit.The efficacy and security of one-stop hybrid cardiac surgery were evaluated after the procedure.Results The one-stop hybrid procedure was successful in all patients.Operation time was （125 ± 28） minutes,CPI time was （65 ± 33） minutes,CPB time was （60 ± 23） minutes,Aortic cross clamping time was （42 ± 18） minutes,postoperative mechanical ventilation time was （20.5 ±6.5）hours and ICU monitoring time was （68.9 ± 16.6）hours.Hospitalization time was （9.8 ± 3.7） days.Patients remained free from angina,prosthetic valve dysfunction and patent ductus arteriosus recanalisation（rang 1 to 5 months） follow-up period.Conclusion One-stop hybrid cardiac surgery provides a reasonable,feasible and safe alternative for treating elderly patients with complex heart disease.

关 键 词：手术 复合 经皮冠状动脉介入术 心脏外科手术 老年人 

分 类 号：R654.2[医药卫生—外科学]