老年患者同期行冠状动脉旁路移植术和瓣膜手术

目的：总结老年患者同期行心脏瓣膜手术和冠状动脉旁路移植术（CABG）的手术效果和临床经验。方法：2005年5月—2010年3月同期行心脏瓣膜手术及冠状动脉旁路移植术的老年患者65例,其中男性52例,女性13例,年龄65-79岁,平均年龄68.1±3.2岁。心脏瓣膜疾病合并冠状动脉病变31例,冠心病合并心脏瓣膜功能不全34例。同期行冠状动脉旁路移植术合并瓣膜成形术17例,合并心瓣膜置换术48例,其中合并带瓣人工血管置换（Bentall手术）3例。平均每例作冠状动脉远端吻合口1.96±0.85个。结果：术后早期病死8例（12.3%）,共出现并发症17例（26.2%）;住院病死患者中2例死于低心排血量,2例死于呼吸衰竭,1例死于肾功能衰竭,1例死于恶性心律失常,2例死于重症感染引发的多器官功能衰竭。再次开胸止血3例。57例患者取得了良好的疗效,心脏功能明显改善。手术后随访48例,失访9例,随访时间1-67个月,平均随访32.2个月,随访期间病死2例,均为非心源性病死。其余患者生活质量明显改善。结论：老年患者同期行心脏瓣膜手术及冠状动脉旁路移植术是安全、有效的,近期效果满意。

Clinical Analysis of Elderly Patients Undergoing Cardiac Valve Surgery Combined with Coronary Artery Bypass Grafting

Objective： To study the surgical results and clinical experience of elderly patients undergoing cardiac valve surgery combined with coronary artery bypass grafting.Methods： From May 2005 to March 2010,a total of 65 elderly patients with heart valve surgery were admitted for receiving coronary artery bypass grafting.Among them,52 patients were male and 13 were females,the mean age were 68.1 ± 3.2 years.There were 31 cases with heart valve disease and coronary artery disease,coronary heart disease with cardiac valve insufficiency in 34 cases.Earlier implementation of coronary artery bypass grafting combined valvuloplasty in 17 cases,the merger of 48 patients undergoing cardiac valve replacement,which combined with a valve graft replacement（Bentall procedure） in 3 cases.Coronary artery distal anastomosis per capita persons 1.96±0.85.Results： Were successfully weaned from cardiopulmonary bypass surgery,early postoperative death in 8 cases（12.3%）,a total of 17 patients with complications（26.2%）.Eight hospitalized patients died,among them 2 patients died of low cardiac output,2 patients died of respiratory failure,1 case died of renal failure,1 died of malignant arrhythmia,2 patients died of severe infections caused by multiple organ failure.Re-thoracotomy to stop bleeding in 3 cases.A total of 57 patients achieved good clinical results,their cardiac function was improved.A total of 48 cases were followed up after surgery,9 patients lost to follow up from 1 to 67 months,average follow-up time were 32.2 months.Two patients died during follow-up,both non-cardiac death.The remaining patients quality of life improved significantly.Conclusions： Elderly patients with heart valve surgery over the same period and purposes of coronary artery bypass grafting is safe and effective,recent results are satisfactory.