老年风湿性心脏瓣膜病合并冠心病的同期手术治疗  

The surgical treatment for senile patients with rheumatic heart valvular disease associated with coronary heart disease

作　　者：杨建国[1] 陶凉[1] 陈绪发[1] 庾华东[1] 

机构地区：[1]武汉亚洲心脏病医院心外科,湖北省武汉市430022

出　　处：《中国心血管病研究》2015年第5期453-456,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结风湿性心脏病（风心病）合并冠状动脉粥样硬化性心脏病（冠心病）的老年患者同期手术治疗的临床经验.方法 回顾性分析武汉亚洲心脏病医院从2010年1月至2013年5月间89例65岁以上风心病合并冠心病患者进行同期瓣膜手术和冠脉搭桥手术治疗的临床资料,其中男性52例、女性37例,平均年龄（70.6±3.4）岁;心功能Ⅱ级10例、Ⅲ级45例、Ⅳ级34例;二尖瓣病变45例,主动脉瓣病变22例,联合瓣膜病变22例;均伴有单支或多支冠状动脉病变.手术行二尖瓣成形17例,行二尖瓣置换28例,行主动脉瓣置换22例,行双瓣置换18例,主动脉瓣置换和二尖瓣成形4例;30例为机械瓣置换,42例为生物瓣置换;冠脉搭桥平均2.2支/例.结果 手术体外循环时间（116.2±22.4）min,主动脉阻断时间（80.5±13.6）min.术后早期死亡4例,死因主要为低心排出量综合征并多器官功能衰竭;其余患者恢复良好.随访79例,随访时间12～52个月,随访期间死亡5例,1例为术后8、12个月消化道出血死亡,2例术后2年死于脑血管意外,1例术后4年死于肺癌.其余患者心功能较术前改善,生活质量提高.结论 对老年风心病合并冠心病患者进行同期瓣膜置换和冠脉搭桥手术治疗是安全可行的,近期疗效满意.Objective To summarize the clinical experience of combined cardiac valve surgery and coro- nary artery bypass grafting （CABG） for rheumatic heart disease （RHD） and coronary atherosclerotic heart disease （CHD） in Senile Patients. Methods From January 2010 to May 2013, 89 patients aged over 65 years underwent valve surgery and coronary artery bypass grafting. The clinical data was analyzed retrospectively. There were 52 males and 37 females. The mean age of the patients was （70.6±3.4）years. Heart function （NYHA）was class I1 in 10 patients, class Ⅲ in 45,class 1V in 34, 45 patients had mitral valve disease, 22 aortic valve lesion, and 22 with lesions of both valves, All cases had single-vessel or multiple-vessel, Mitral valvular plasty was performed in 17 cases, mitral valve replacement was in 28 cases, aortic valve replacement was in 22 cases, double valve re- placement was in 18 cases, aortic valve replacement combined with mitral valve repair in 4 cases. 30 patients were employed mechanical valves, 42 patients were employed bioprostheses. The mean grafts were 2.2 per patient. Results The cardiopulmonary bypass time and aortic clamp time were （116.2±22.4） and （80.5±13.6）minutes. Early death happened in 4 cases because of severe low output syndrome and multiple organ failure, the others re- covered completely. 79 （92.9%） patients were followed up from 12 to 52 months. During the follow-up, 5 patients died of gastrointestinal hemorrhage, lung carcinoma and cerebral infarction. The survivors had improved heart func- tion and life quality substantially. Conclusion The simultaneous cardiac valve surgery and coronary artery bypass grafting for patients with RHD and CHD are safe and effective.

关 键 词：风湿性心脏病 冠状动脉粥样硬化性心脏病 同期手术 

分 类 号：R654.2[医药卫生—外科学]