摘要
目的介绍冠状动脉旁路术(CABG)同时行心脏瓣膜手术的临床经验,分析手术死亡的危险因素,提高手术的成功率。方法2002年10月～2008年2月20例冠状动脉旁路移植术同期行瓣膜手术,患者年龄43～76岁,平均59岁,术前心功能(NYHA)Ⅱ级8例,Ⅲ级10例,Ⅳ级2例;二尖瓣病变12例,主动脉瓣病变5例,联合瓣膜病变3例,均伴有单支或多支冠状动脉病变。手术在中度低温体外循环下完成。心脏停跳后,先作静脉桥的远端吻合,然后置换瓣膜或成形。心脏复苏完成后完成大隐静脉与升主动脉吻合,或在升主动脉1次阻断下完成。内乳动脉的吻合在瓣膜手术后心脏复苏前完成,本组2例行二尖瓣成形,18例行机械瓣置换,未用生物瓣。结果术后早期死亡2例(10%),主要死亡原因:低心排血量,急性肾功能衰竭,严重心率失常等,相关危险因素分析结果显示:术前有心肌梗死史、心功能差、心胸比率大、女性等与早期死亡有关。随访18例,时间6个月～4年患者无死亡,心功能I级12例,Ⅱ级6例。结论CABG联合心瓣膜手术是治疗冠心病合并瓣膜病变的有效方法,术前积极改善心功能,术中加强心肌保护,缩短手术和心肌缺血时间以及完全的再血管化能有效的提高手术成功率。女性病人的并发症发生率和病死率高于男性。这与女性的低体重、冠状动脉细小及风湿性二尖瓣狭窄病变等构成的独立危险因素有关。
[Objective] To evaluate the experience of coronary artery bypass grafting （CABG） combined with concomitant valve operation. [Methods] From 2002 to 2008, twenty patients underwent CABG combined with concomitant valve operation. The mean age of the patients was 59 years （43 to 76 years）. Heart function was Class Ⅱ （NYHA） in 8 patients, Class Ⅲ in 10,Class IV in 2,valves repaired in 2 patients, mechanical valve replacement in 18 patients. 12 mitral patients had mitral valve lesion, 5 aortic lesion, and 3 both lesions. Total patients had singlevessel or triple-vessel diseases. After cardiac arrest by cold blood cardioplegia under moderate eardiopulmonary bypass （CPB）. Distal anastomoses of the saphanous vein （SV） to the target vessels were firstly performed and followed by valve operation. [Results] The hospital mortality rate was 10%. The primary cause of death included low cardiac output syndrome, acute renal failure, severe ventricular arrhythmia. Multivariate testing of preoperative and operative description identified that preoperative myocardial infarction, worse cardiac function, radiographic cardiac enlargement low ejection fraction and females were associated with an increase of hospital mortality （P 〈0.05）. Follow-up of 18 patients, range 6 months to 4 years, Class I in 12, Class II in 6. [Conclusions] Combined CABG and valve operation is an effective way for treatment of coronary artery and valvular heart disease. Improving the heart funetion preoperatively, strengthening myocardial protection, shortening operation and myocardial isehemia time, and complete revascularization are the key faction for success operation. The rate of morbidity and mortality of complication of females is more than that of male. The study demonstrates that female gender is independent risk factor for combined morbidity and mortality during and after combined valve and coronary bypass sugery. That is related to low weight and rnitral valve stenosis of female
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2009年第9期1411-1413,共3页
China Journal of Modern Medicine
关键词
冠状动脉旁路术
心脏瓣膜手术
手术后并发症
coronary artery bypass grafting
heart valve surgery
postoperative complications
