心脏瓣膜置换同期行冠状动脉旁路移植术107例临床分析

目的总结笔者所在科室同期行心脏瓣膜置换和冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的患者围术期临床特点及处理方法。方法回顾性分析1998年4月～2011年3月期间冠心病合并瓣膜病患者107例,男性82例,女性25例,平均年龄60岁(39～78岁),术前心功能(NYHA)Ⅱ级者18例,心功能Ⅲ级者72例,Ⅳ级者17例。二尖瓣病变71例,主动脉瓣病变24例,二尖瓣合并主动脉瓣病变12例。冠状动脉单支病变57例,2支病变29例,多支病变21例,左主干病变11例。合并左房血栓22例。行二尖瓣置换53例,二尖瓣成形9例,主动脉瓣置换24例,双瓣置换12例,其中26例同时行三尖瓣成形术,22例同时行左房血栓清除术。桥血管共计152支,其中动脉桥44支,平均血流量28.6±5.1ml/min。静脉桥108支,平均血流量23.3±4.8ml/min。对上述患者的临床资料进行统计学分析。结果术后死亡2例(病死率1.9%),死亡原因分别为恶性心律失常和严重感染。二次开胸止血2例。围术期应用主动脉内球囊反搏(intra-aortic balloon pumping,IABP)6例(5.6%)。心脏超声显示术后左房及左室内径较术前明显缩小(分别为P=0.029和P=0.001)。75例患者术后随访4个月～13年,患者心功能改善,心绞痛症状消失。结论对于冠心病合并瓣膜病患者,充分的术前评估,正确的术中、术后处理,可以降低心脏瓣膜置换同期行CABG的病死率。

Clinical Analysis of Cardiac Valve Replacement and Coronary Artery Bypass Grafting in 107 Cases

Objective To review the clinical characteristics and perioperative management of patients underwent cardiac valve replacement and coronary artery bypass grafting.Methods From April 1998 to March 2011,a total of 107 patients including 82 male and 25 female received combined cardiac valve replacement and coronary artery bypass grafting(CABG) in our hospital.Heart function was as follow:class Ⅱ in 18,class Ⅲ in 72,class Ⅳ in 17.71 patients had mitral valve lesion,24 with aortic valve lesion,12 with double valve lesion.57 cases had single-vessel disease,29 with double-vessel disease,21 with triple-vessel disease,11 with left main artery stenosis.There were 53 patients undergoing a combination of CABG with mitral valve replacement,9 patients with mitral valve repair,24 patients with aortic valve replacement,12 patients with mitral valve and aortic valve(double valve) replacement.There were 152 grafts in all,including 44 artery grafts and 108 vein grafts,which mean blood flow were 28.6±5.1ml/min and 23.3±4.8ml/min respectively.Results Three patients died after operation,because of malignant arrhythmia,severe pulmonary hypertension,and severe infection respectively.Two patients received reoperation for bleeding.Other patients were discharged.Seventy-fire patients were followed up from 4 months to 13 years with improved heart function and free of angina.Conclusion Proper perioperative management can decrease the mortality of CABG combined with valve surgery.