左室扩大对中-重度缺血性二尖瓣关闭不全患者同期行CABG+MVP术的影响  

Effect of left ventricular enlargement on moderate to severe ischemic mitral valve regurgitation patients undergoing simultaneous CABG + MVP

作　　者：舒悦 何书武 王天光 陈泽伦 郭义龙 SHU Yue;HE Shuwu;WANG Tianguang;CHEN Zelun;GUO Yilong(The Second Affiliated Hospital of Hainan Medical University, Haikou 570102, China)

机构地区：[1]海南医学院第二附属医院,海口570102

出　　处：《山东医药》2019年第11期40-43,共4页Shandong Medical Journal

摘　　要：目的分析左室扩大对中-重度缺血性二尖瓣关闭不全(IMR)患者同期行冠状动脉旁路移植术(CABG)+二尖瓣成形术(MVP)术的影响,为该类患者的外科治疗提供借鉴。方法回顾性分析在我院接受CABG+MVP治疗的54例伴左室扩大的中-重度IMR患者的临床资料,根据术前左室扩大程度分为左室轻度扩大者(A组) 16例、左室中度扩大者(B组) 30例、左室重度扩大者(C组) 8例。患者均在中-低温体外循环辅助下行CABG+MVP治疗。比较三组术前基础病变情况包括心功能、冠状动脉病变。记录并比较三组术中主动脉阻断时间、体外循环时间、复苏时间。术前、术后24 h及术后6个月时行心脏彩超检查,比较手术前后心功能指标包括左室舒张末径(LVEDD)、左室射血分数(LVEF)及二尖瓣返流面积(MRA)。比较三组术后6个月内常见并发症的发生情况。结果 C组左主干+三支血管病变的比例高于A、B组(P <0. 05)。C组主动脉阻断时间、体外循环时间及复苏时间均长于A、B组(P均<0. 05)。术前及术后24 h时,C组LVEDD均高于B、A组(P均<0. 01);术后6个月时,C组LVEDD高于B组(P <0. 01);术前及术后6个月时,C组MRA均高于A、B组(P均<0. 01);术后24h时,C组LVEF低于A、B组(P <0. 01)。C组术后低心排的发生率高于A、B组(P均<0. 05)。结论左室轻中度扩大的IMR患者推荐同期行CABG+MVP治疗,而左室重度扩大的IMR患者行CABG+MVP的效果不佳。Objective To investigate the short-term outcomes of coronary artery bypass grafting (CABG) combined with mitral valvuloplasty (MVP) in patients with moderate to severe ischemic mitral valve regurgitation (IMR) and left ventricular enlargement. Methods Fifty-four selected patients were divided into three groups: group A (mild): left ventricular end diastolic diameter (LVEDD) 50-60 mm,( n =16);group B (moderate): LVEDD 60-70 mm,( n =30);group C (severe): LVEDD greater than 70 mm,( n =8). All patients were treated by CBAG + MVP at the same time with moderate-hypothermic cardiopulmonary bypass. The basic pathological changes of these three groups, such as cardiac function and coronary artery lesions before operation were compared. The clamp time, cardiopulmonary bypass time and recovery time of these three groups were recorded and compared. Echocardiography was performed for every patient before operation, 24 hours and 6 months after operation. The left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation area (MRA) were compared before and after operation. Meanwhile, the common complications of these three groups within 6 months after operation were compared. Results The incidence rate of left main and three vessel disease in the group C was higher than that in the groups A and B ( P <0.05). The clamp time, recovery time, and cardiopulmonary bypass time in the group C were longer than that in the groups A and B (all P < 0.05 ). The LVEDD of the group C was higher than that of group B and group A before operation and 24 hours after operation ( P <0.01). At 6 months after operation, LVEDD in the group C was higher than that in the group B ( P <0.01). The MRA of group C was higher than that of groups A and B before operation and 6 months after operation ( P <0.01). At 24 hours after operation, the LVEF of group C was lower than that of group A and group B ( P <0.01). The incidence of low cardiac output in the group C was higher than that in the group A and group

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

分 类 号：R654.2[医药卫生—外科学]