心脏瓣膜手术同期冠状动脉旁路移植术的临床探讨

目的 探讨心脏瓣膜手术同期冠状动脉旁路移植术的治疗效果.方法 回顾性分析2010年1月至2013年8月新疆医科大学第一附属医院心脏外科心脏瓣膜手术同期行冠状动脉旁路移植术45例患者的临床病例资料,对其进行整理统计分析,评价治疗效果.结果 患者术后左心室舒张末径较前明显减小,差异均有统计学意义（P＜0.01）;左心室射血分数较术前明显升高,差异均有统计学意义（P＜0.05）.术后早期（住院期间）死亡3例,其中2例发生低心排综合征、1例室颤均抢救无效死亡.通过电话及门诊复查,随访3～24个月,2例失访,失访率4.44％,无一例死亡.结论 心脏瓣膜手术同期行冠状动脉旁路移植术的治疗效果满意.充分的术前准备、合理的手术方案、有效的心肌保护措施、熟练的手术技术及术后的重症监护治疗是手术成功的关键.

Clinical study of cardiac valve surgery with coronary artery bypass grafting

Objective To explore the therapeutic effect of cardiac valve surgery with coronary artery by- pass grafting. Methods 45 cases of clinical documents were analyzed, which was due to cardiac valve surgery combined with coronary artery bypass grafting from January 2010 to August 2013. And the therapeutic affections were evaluated. Results Compared with the preoperation, left ventricular end-diastolic diameter postoperation was sigrfificanfly decreased （P〈0.01）. Left ventricular ejection fraction was significantly increased compared with the preoperative, which was also differenced significantly in statistics （P〈0.05）. After operation, three patients died during hospitalization, two cases had low cardiac output syndrome, one cases had ventricular fibriUation, all the six patients were dead. The left patients were followed up 3-24 months by phone and patient review, two cases were lost to be followed, the rate of the lost was 4.44%, and no one died during follow-up period. Conclusion The therapeutic effect of cardiac valve surgery with coronary artery bypass grafting are satisfy. The key of successful surgery is fully preparation of preoperation, reasonable surgical approach, effective myocardial protection measures, skilled surgical technique and postoperative intensive care.