外科治疗冠心病合并中度缺血性二尖瓣反流围手术期疗效分析  

Assessment of perioperative outcomes of surgery in patients with coronary heart disease and moderate ischemic mitral regurgitation

作　　者：宋跃[1] 董然[1] 党海明[1] 吴立松[1] 曹剑[1] 刘冬[1] 黄琦[1] 马小龙[1] Song Yue;Dong Ran;Dang Haiming;Wu Lisong;Cao Jian;Liu Dong;Huang Qi;Ma Xiaolong(Department of Cardiac Surgery,Anzhen Hospital,Affiliated to Capital University of Medical Science,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2020年第10期613-616,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨单独冠状动脉旁路移植术(CABG)或CABG+二尖瓣成形术(MVP)治疗冠状动脉粥样硬化性心脏病(冠心病)合并中度缺血性二尖瓣反流(IMR)的围手术期疗效。方法收集北京安贞医院2018年1月至2019年12月间210例接受外科手术治疗的冠心病合并中度IMR患者临床资料,其中男155例,女55例;年龄(62.3±8.5)岁。根据患者手术方式分为CABG组(138例)和CABG+MVP组(72例),对比分析两组基线特征及围手术期相关指标。结果两组在年龄、性别、合并症(糖尿病、高血压、高脂血症、外周血管疾病、脑血管事件、既往心肌梗死史和经皮冠状动脉介入治疗史)、左心室射血分数(LVEF)和冠状动脉病变支数等方面差异均无统计学意义(P>0.05)。两组旁路移植血管吻合均以序贯吻合方式为主,多数患者使用乳内动脉,但组间差异无统计学意义(P>0.05)。CABG组全因性死亡、心衰、脑血管事件、二次开胸和持续性肾脏替代治疗和主动脉内球囊反搏辅助治疗的发生比例均高于CABG+MVP组,但组间差异无统计学意义(P>0.05)。术后复查超声心动图提示两组患者心功能指标均比术前有改善,CABG+MVP组的LVEF、左心室舒张末期内径和左心室收缩末期内径均高于CABG组,但组间差异无统计学意义(P>0.05);CABG+MVP组的术后二尖瓣反流面积平均值为1.3 cm^2,明显低于CABG组(2.5 cm^2),差异有统计学意义(P<0.05)。结论CABG+MVP治疗冠心病合并中度IMR围手术期风险低,纠正二尖瓣反流效果满意。Objective To explore the perioperative effect of coronary artery bypass grafting(CABG)or CABG+mitral valve repair(MVP)in patients with coronary heart disease(CAD)and moderate ischemic mitral regurgitation(IMR).Methods The clinical data and perioperative complications of 210 patients with CAD and moderate IMR,who underwent CABG from January 2018 to December 2019,were included into this study,with 155 males and mean age of(62.3±8.5)years old.According to the operation mode,patients were divided into CABG group(138 cases)and CABG+MVP group(72 cases).Results There were no significant differences in age,gender,comorbidities(diabetes,hypertension,hyperlipidemia,peripheral vascular disease,cerebrovascular events,previous history of myocardial infarction and PCI),LVEF and of coronary artery lesions between the two groups(all P>0.05).Sequential anastomosis was the main method,and most patients underwent internal mammary artery graft in both groups,there was no significant difference between the two groups(P>0.05).CABG group was higher than CABG+MVP group in all-cause death,heart failure,cerebrovascular events,secondary thoracotomy,CRRT and IABP support events,but there were no significant differences between the two groups(P>0.05).Echocardiographic reexamination showed that the indexes of cardiac function in CABG+MVP group were higher than those in CABG group,but there was no significant difference between the two groups(P>0.05).The mean area of mitral regurgitation in CABG+MVP group was 1.3 cm^2,significantly lower than that in CABG group(2.5 cm^2),P<0.05.Conclusion CABG+MVP has low perioperative risk in patients with CAD and moderate IMR,and the area of mitral regurgitation is lower.

关 键 词：中度缺血性反流 冠状动脉旁路移植术 二尖瓣成形术 围手术期 

分 类 号：R654.2[医药卫生—外科学]