冠状动脉旁路移植复合二尖瓣手术在治疗冠心病合并中度缺血性二尖瓣关闭不全中的应用分析  

Application of coronary artery bypass grafting combined with mitral valve surgery in the treatment of coronary heart disease with moderate ischemic mitral regurgitation

作　　者：姬建民 张建卿 王国锋[1,2] 陈高杰 樊宗明[1,2] JI Jiannmin;ZHANG Jianqing;WANG Guofeng;CHEN Gaojie;FAN Zongming(Department of Cardiovascular Surgery,Zhengzhou Seventh People's Hospital of Xinxiang Medical College,Xinxiang 453003,China)

机构地区：[1]新乡医学院,453003 [2]河南省郑州市第七人民医院心脏外科

出　　处：《心肺血管病杂志》2020年第8期942-946,951,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析中度缺血性二尖瓣关闭不全(IMR)患者,在冠状动脉旁路移植术(CABG)同时行二尖瓣手术治疗的近中远期结果,探讨CABG术复合二尖瓣手术(MVP)治疗中度IMR的手术策略。方法:将2012年至2017年,进行手术的62例冠心病合并中度IMR患者分为A、B两组,其中A组为:单纯CABG组49例,B组为:同期行二尖瓣成形复合手术(CABG+MVP)组13例,对两组患者的术前资料、围术期手术情况以及术前、术后3、12、24个月的LVEDD、LVEDV、LVEF、二尖瓣关闭不全(MR)程度、心功能分级(NYHA分级)、生存情况、主要不良心血管事件(MACCEs)等进行分析。结果:①两组在年龄、性别、梗死部位、既往介入术、卒中史等方面,差异无统计学意义(P>0.05);②两组在围术期移植支数、术中复合其他手术(室壁瘤切除等)、机械通气时间及发生二次开胸止血、恶性心律失常、LCOS、呼吸功能不全、再次MR、院内死亡等,差异无统计学意义(P>0.05);③两组术后随访3、12、24个月除LVEF外,LVEDD、LVEDV较术前改善等变化,差异有统计学意义(P<0.05),两组NYHA分级术前无差别(P>0.05);术后24个月随访时:再次MR发生率B组低于A组(18.2%vs.36.5%,P<0.05),NYHA分级B组优于A组(P<0.05),A组对B组的死亡率(8.7%vs.零,P>0.05)、MACCEs发生率(8.7%vs.零,P>0.05)。结论:在充分冠状动脉再血管化原则下,CABG术复合二尖瓣手术治疗冠心病合并中度IMR术后并发症不多,中远期二尖瓣再次处理机率较低,心功能较好,未显著增加中风等MACCEs,有稳定和长期的获益,疗效确切。Objective:To analyze the short and longterm result of patients with moderate ischemic mitral regurgitation(IMR)who underwent mitral valve surgery with coronary artery bypass grafting(CABG),and to explore the feasiblity of surgical strategies for IMR.Methods:A total of 62 patients diagnosed with moderate IMR had been operated from 2012 to 2017.We divide them into two groups A including CABG alone in 49 cases and B with mitral valve repair(CABG+MVP)in 13 cases during the same period of CABG.Based on the pre-operative general clinical data,peri-operative conditions and at pre-operation,3 months,12 months and 24 months post-operation in LVEDD,LVESV,LVEF,mitral regurgitation(MR)grading,heart function classification(NYHA classification),survival,major adverse cardiac events(MACCEs),we analyze thier statistical differences.Results:①There was no significant differences between the two groups in age,gender,previous PCI,cerebral infarction,hypertension,ect.(P>0.05).②The statistical differences is not significant(P>0.05)in these aspects,such as the vessels number of bypass grafts,combined with other surgeries(ventricular wall tumor resection,etc.),mechanical ventilation time and occurrence of secondary thoracotomy to stop bleeding,malignant arrhythmia,LCOS,respiratory insufficiency,recurrent MR and hospital death.③The grading of LVEDD,LVEDV at 3 months,12 months and 24 months post-operation improved compared with that of pre-operation,with statistically significant changes(P<0.05),but they were not statistically significant(P>0.05)in LVEF.The incidence of recurrent MR in the B group was lower(18.2%vs.36.5%,P<0.05)and it has statistical differences.There was no difference in NYHA classification pre-operation between the two groups(P>0.05),follow-up at 24 months,the group B was better than group A(P<0.05).The mortality(8.7%vs.0,P>0.05)and incidence of MACCEs(8.7%vs.0,P>0.05)in terms of A group to B group were not statistically significant.Conclusions:Under the principle of sufficient revascularization,application of cor

关 键 词：缺血性二尖瓣关闭不全 冠心病 冠状动脉移植术 二尖瓣手术 

分 类 号：R54[医药卫生—心血管疾病]