心脏不停跳冠脉搭桥术同期行瓣膜置换术对冠心病合并心脏瓣膜病患者预后的影响  

Prognostic Effect of Valve Replacement in Patients with Coronary Heart Disease Combined with Valvular Heart Disease After Non-stop Coronary Artery Bypass Grafting

作　　者：曹向波[1] 史博伦 李艳凤[1] 何发明[1] CAO Xiangbo;SHI Bolun;LI Yanfeng;HE Faming(CSICU,Henan Provincial Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院CSICU,河南郑州450000

出　　处：《河南医学研究》2024年第6期1022-1025,共4页Henan Medical Research

摘　　要：目的分析心脏不停跳冠脉搭桥术同期行瓣膜置换术治疗冠心病(CHD)合并心脏瓣膜病患者的效果。方法回顾性收集2021年8月至2023年8月河南省胸科医院接收的CHD合并心脏瓣膜病患者92例为研究对象,依据1∶1配对原则进行分组,其中接受心脏不停跳冠脉搭桥术同期行瓣膜置换术46例纳入不停组,接受停跳体外循环下冠脉搭桥术同期行瓣膜置换术46例纳入停跳组。对比两组手术指标、并发症状况、心功能分级状况、心脏超声指标[左室射血分数(LVEF)、左房舒张末前后径(LAEDD)、左室舒张末期内径(LVEDD)]、心肌受损指标[心肌肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)]。结果不停组手术时间、住院时间、ICU入住时间短于停跳,24 h引流量少于停跳组(P<0.05)。不停组术后3个月心功能分级优于停跳组(P<0.05),LAEDD、LVEDD小于停跳组,LVEF高于停跳组(P<0.05)。术后7 d不停组血清CK-MB、cTnⅠ水平低于停跳组(P<0.05)。结论心脏不停跳冠脉搭桥术同期行瓣膜置换术治疗CHD合并心脏瓣膜病患者效果确切,可有效缩短康复进程,改善心功能,减轻心肌损伤,且安全性高。Objective To analyze the effect of valve replacement in the treatment of patients with coronary heart disease(CHD)combined with valvular heart disease after non-stop coronary artery bypass grafting.Methods A retrospective study was conducted on 92 patients with CHD complicated with valvular heart disease admitted to the Chest Hospital of Henan Province from August 2021 to August 2023.They were divided into two groups based on a 1∶1 pairing principle.Among them,46 patients who received non-stop coronary artery bypass grafting and underwent valve replacement during the same period were classified as non-stop group,and 46 patients underwent coronary artery bypass grafting under extracorporeal circulation and underwent value replacement during the same period were classified as stop beating group.Surgical indexes,complications,cardiac function grading,echocardiographic indexes[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LAEDD),left ventricular anteropodiastolic diameter(LVEDD)],myocardial injury indexes[cardiac troponinⅠ(cTnⅠ),creatine kinase isoenzyme(CK-MB)]of the two groups were compared.Results The surgery time,hospitalization time,and ICU stay time of the non-stop group were shorter than the stop beating group,the 24-hour flow rate was less than that of the stop beating group(P<0.05).The heart function grading of the non-stop group was better than that of the stop beating group at 3 months after surgery(P<0.05),LAEDD and LVEDD were lower than those of the stop beating group,and LVEF was higher than that of the stop beating group(P<0.05).The serum CK-MB and cTnⅠlevels in the non-stop group were lower than those in the stop beating group at 7th days after surgery(P<0.05).Conclusion Continuous coronary artery bypass grafting and valve replacement surgery are effective in treating patients with CHD complicated with valvular heart disease.They can effectively shorten the recovery process,improve heart function,reduce myocardial damage,and have high safety.

关 键 词：冠状动脉搭桥术 心脏瓣膜置换术 预后 心瓣膜 冠心病 

分 类 号：R541[医药卫生—心血管疾病]