冠状动脉旁路术同期行心脏瓣膜替换术治疗冠心病心脏瓣膜病变的临床研究  

Clinical study of coronary artery bypass grafting with simultaneous cardiac valve replacement in the treatment of coronary heart disease with heart valve disorder

作　　者：黄志辉[1] 张剑彬[1] 刘治元[1] 欧斌[1] 黄思纳 徐崇斐 

机构地区：[1]广东省梅州市人民医院心脏大血管外科,广东梅州514031

出　　处：《中国当代医药》2017年第7期53-55,59,共4页China Modern Medicine

摘　　要：目的分析冠状动脉旁路术同期行心脏瓣膜替换术治疗冠心病心脏瓣膜病变的临床效果。方法选取2010年10月~2016年11月我院收治的32例冠心病心脏瓣膜病变患者,所有患者均行冠状动脉旁路术同期行心脏瓣膜替换术,其中行二尖瓣置换加搭桥25例,主动脉瓣置换加搭桥4例,二尖瓣、主动脉瓣置换加搭桥3例。分析所有患者术后情况、心脏功能恢复情况、并发症发生率及随访情况。结果患者术后呼吸机使用时间为(34.59±2.85)h,ICU监护时间为(4.74±1.62)d,住院时间为(13.29±2.33)d。术后左心室射血分数明显高于术前,左心室舒张末期内径及收缩末期内径均小于术前,差异有统计学意义(P<0.05)。32例患者中,11例患者出现术后并发症,并发症发生率为34.38%。随访可知,所有患者术后心功能情况均得到改善,其中29例(90.63%)患者得到较明显的恢复,3例(9.38%)患者需要安装永久心脏起搏器(1例术后14 d安装,1例术后398 d安装,另1例术后851 d安装),但无瓣周漏发生。结论冠状动脉旁路术同期行心脏瓣膜替换术在治疗冠心病心脏瓣膜病变中临床效果显著,可有效改善患者心功能状态,远期预后效果好,值得在临床中推广应用。Objective To analyze the clinical effect of coronary artery bypass grafting （CABG） and simultaneous cardiac valve replacement in the treatment of coronary heart disease （CHD） with heart valve disorder.Methods 32 patients with CHD with heart valve disorder admitted into our hospital from October 2010 to November 2016 received CABG and si- multaneous cardiac valve replacement.There were 25 cases of mitral valve replacement and bypass,4 cases of aortic valve replacement and bypass,3 cases of mitral valve replacement,aortic valve replacement and bypass.The postopera- tive situation,recovery of cardiac function,incidence of complications and follow-up of all patients were analyzed.Re- sults The postoperative ventilator time of patients was （34.59±2.85） h,ICU monitoring time was （4.74±1.62） d,hospital stays was （13.29±2.33） d.The left ventricular ejection fraction after surgery was significantly higher than that before surgery,and left ventricular end-diastolic dimension and end-systolic dimension was smaller than that before surgery （P〈0.05）.There was 11 cases of postoperative complications among 32 cases of patients,and the incidence of complica- tions was 34.38%.According to follow-up of patients,the cardiac function of all patients improved after surgery,and 29 cases （90.63%） significantly recovered,3 cases （9.38%） needed to install permanent cardiac pacemaker （1 case of in- stallation 14 d after surgery,1 case of installation 398 d after surgery,1 case of installation 851 d after surgery）,but without perivalvular leakage.Conclusion CABG and simultaneous cardiac valve replacement in treating CHD with heart valve disorder has significant clinical effects,it can effectively improve cardiac function state and has good long-term prognostic effects,which is worthy of clinical application.

关 键 词：冠状动脉旁路术 心脏瓣膜替换术 冠心病心脏瓣膜病变 

分 类 号：R654.2[医药卫生—外科学]