冠状动脉搭桥同期行心脏瓣膜替换术35例的体会

目的回顾总结35例冠状动脉搭桥术（CABG）同期行心脏瓣膜替换手术的方法及疗效,分析手术死亡的危险因素,提高手术的成功率.方法 2005年1月至2010年3月,共行CABG＋心脏瓣膜替换术35例,共移植血管105支,平均每例移植血管2.86支.同期行二尖瓣替换术16例,主动脉瓣替换术12例,双瓣膜替换术5例,本特氏手术例,升主动脉替换1例（替换机械瓣28例、生物瓣7例）.结果术后早期死亡2例,术后平均住院时间17.2d.主要死亡原因：急性肾功能衰竭1例、心室颤动致心脏骤停1例.相关危险因素分析：术前有心肌梗塞病史、心功能差、射血分数低、肾功能不全等与早期死亡有关.术后发生并发症包括内出血、严重室性心律失常、神经系统并发症、切口感染等,经相应的治疗均痊愈.随访12例（34.2%）,随访时间6～12个月,心绞痛和心力衰竭症状、体征均明显改善.结论 CABG联合心脏瓣膜替换术是治疗冠心病合并心脏瓣膜病变的有效方法,术前积极改善心肺功能、有效控制血糖、术中加强心肌保护、缩短主动脉阻断和心肌缺血时间以及尽可能的心肌再血管化能有效地提高手术成功率。

The Experiences of Coronary Artery Bypass Grafting Combined with Valve Replacement Surgery in 35 Patients

Objective To summarize the method and effect of coronary artery bypass grafting（CABG） combined with valve replacement surgery in 35 patients,analyze the risk factors of operative mortality,and improve the success rate of surgery.Methods From January 2005 to March 2010,35 ptients received CABG combined with cardiac valve replacement surgery.All patients received 105 grafts,an average of 2.86 grafts per patient.Meanwhile,16 patients received mitral valve replacement,12 patients received aortic valve replacement,5 patients were given double-valve replacement,1 patient was given special replacement,and 1 patient was given ascending aorta replacement.All valve replacement cases included mechanical valve replacement in 28 cases and biological valve replacement in 7 cases.Results Two patients died in the early stage after surgery.The postoperative hospital stay of patients was 17.2 days on average.Leading causes of death：acute renal failure in 1 case and ventricular fibrillation induced cardiac arrest in 1 case.Risk factors：the history of preoperative myocardial infarction,heart dysfunction and lowejection fraction,renal insufficiency are related with death in the early stage after surgery.Postoperative complications included hemorrhage,severe ventricular arrhythmias,neurological complications,wound infection.All patients with postoperative complications were cured by appropriate treatment.12 patients（34.2%） were followed for 6 to 12 months,angina and heart failure symptoms and signs were improved significantly.Conclusions CABG combined with heart valve replacement is an effective treatment way for coronary heart disease combined with valvular heart disease.The success rate of surgery can be improved by actively improving cardiopulmonary function before surgery,effective control of blood sugar,enhancing myocardial protection and reducing the aortic cross-clamping and myocardial ischemia time,and as far as possible revascularization.