单纯冠状动脉旁路移植术治疗冠心病合并中度缺血性二尖瓣关闭不全中期疗效分析  

Analysis on the efficacy of coronary artery bypass graft alone in the treatment of coronary heart disease with moderate ischemic mitral regurgitation

作　　者：张魁[1] 董然[1] 刘韬帅[1] 郑居兵[1] 李扬[1] 赵洋[1] 侯雪见 付威 ZHANG Kui;DONG Ran;LIU Taoshuai;ZHENG Jubing;LI Yang;ZHAO Yang;HOU Xuejian;FU Wei(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capita Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科,100029 [2]首都医科大学研究生院

出　　处：《心肺血管病杂志》2019年第1期40-43,61,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市科学科技委员会"首都市民健康项目培育"(Z151100003915084)

摘　　要：目的:比较冠心病合并中度缺血性二尖瓣关闭不全(IMR)患者冠状动脉旁路移植术(CABG)和CABG+二尖瓣成形(MVP)两种手术方法的中期临床疗效。方法:根据入排标准选取2013年1月至2018年11月,于行外科手术治疗的冠心病合并中度IMR患者125例,随访时间12个月,根据手术方式分为CABG组和CABG+MVP组,比较两组术后并发症、呼吸机使用时间、ICU时间、住院时间、在院病死率、术前、术后及随访时EF、LVEDD、二尖瓣反流面积、随访期病死率、MACCE事件发生率等指标。结果:两组患者基线资料,差异无统计学意义(P>0.05),乳内动脉使用率(69.9%vs. 57.1%,P>0.05)、旁路移植支数[(3.05±0.66)vs.(2.95±0.59)支,P>0.05]、悬红[(1.73±2.77)vs.(2.57±4.48)U,P>0.05]、血浆[(139.7±300.8)vs.(190±375.63)mL,P>0.05]、血小板[(0.31±1.31)vs.(0.24±0.7)U,P>0.05]使用量上差异无统计学意义,但CABG+MVP组手术时间明显高于CABG组[(348±87.1)vs.(236.79±65.3)min,P<0.001]。两组在院病死率差异无统计学意义(3.6%vs. 9.5%,P>0.05)。但CABG组IABP使用率(15.7%vs. 33.3%,P<0.05)、呼吸机使用时间[26.0(21.0,52.0)vs. 46(24.3,70.5)h,P<0.05],ICU滞留时间[42.0(23.2,65.9)vs. 63.4(44.3,118.8)h,P<0.05]、术后心房颤动(0 vs. 14.3%,P<0.05)、二次开胸(1.2%vs. 9.5%,P<0.05)、术后肾衰竭(1.2%vs. 9.5%,P<0.05)、低心排发生率(3.6%vs. 19%,P<0.05)、总住院时间[(11.1±4.3)vs.(13.8±6.6)d,P<0.05]均低于CABG+MVP组。两组随访MACCE事件发生率(6.25%vs. 5.26%,P>0.05)、病死率(6.25%vs. 5.3%,P>0.05)差异无统计学意义。除去死亡病例,对比两组超声结果发现,两组患者术后EF [(52.2±8.8)%vs.(50±9.8)%,P>0.05]、术后LVEDD [(49.7±6.1)vs.(49.8±6.3)mm,P>0.05]、术后二尖瓣反流面积[1.7(0,2.7)vs. 0.6(0,2.4)cm^2,P>0.05]、随访EF [(56±8.8)%vs.(52.8±9.1)%,P>0.05]、随访LVEDD [(49.8±5.6)vs.(50.9±5.6)mm,P>0.05]差异无统计学意义,但1年期随访二尖瓣反流面积CABG+MVP组明显少于CABG组[2.4(1.3,3.6)vs. 0.8(0.Objective:To compare the mid-term clinical efficacy of CABG versus CABG+MVP in patients of coronary heart disease combined with moderate ischemic mitral regurgitation(IMR).Methods:according to the criteria,we selected 125 cases,which received surgical treatment between January 2013 and November 2017.We followed up for 12 months.These cases were divided into CABG and CABG+MVP group,according to the operation method.We compared postoperative complications ratio,intubation time,ICU time,hospital stay time,in-patient mortality,preoperative and postoperative and follow-up EF,LVEDD,mitral valve regurgitation area,incidence of MACCE and follow-up mortality between two groups.Results:There was no statistically significant difference in baseline data between the two groups(P >0.05).The utilization rate of internal mammary artery(69.9%vs.57.1%,P >0.05),the number of bypass graft vessels[(3.05±0.66)vs.(2.95±0.59)P >0.05],suspended red blood cells volume[(1.73±2.77)vs.(2.57±4.48)U,P >0.05],plasma volume[(139.7±300.8)vs.(190±375.63)mL,P >0.05]and platelets volume[(0.31±1.31)vs.(0.24±0.7)U,P >0.05]were no statistically significant difference.But the operation time of CABG+MVP group was significantly longer than that of CABG group[(348±87.1)vs.(236.79±65.3)min,P<0.001].There was no significant difference in hospital mortality between the two groups(3.6%vs.9.5%,P >0.05).However,in CABG group,IABP utilization rate(15.7%vs.33.3%,P<0.05),intubation time[26.0(21.0,52.0)vs.46(24.3,70.5)h,P<0.05],ICU time[42.0(23.2,65.9)vs.63.4(44.3,118.8)h,P<0.05],postoperative atrial fibrillation ratio(0 vs.14.3%,P<0.05),thoracotomy hemostasis(1.2%vs.9.5%,P<0.05),renal failure(1.2%vs.9.5%,P<0.05),low cardiac output(3.6%vs.19%,P<0.05)and the total length of hospitalization[(11.1±4.3)vs.(13.8±6.6)d,P<0.05]were all lower than CABG+MVP group.The incidence of MACCE events(6.25%vs.5.26%,P >0.05)and mortality(6.25%vs.5.3%,P >0.05)were not significantly different between the two groups in follow-up period.Excepted the death cases,we found that p

关 键 词：冠心病 中度缺血性二尖瓣关闭不全 冠状动脉旁路移植术 二尖瓣成形 

分 类 号：R54[医药卫生—心血管疾病]