风湿性心脏病合并冠心病的同期外科治疗

Combined Coronary Artery Bypass Grafting with Cardiac Valve Operations of Rheumatic Heart Disease

目的探讨风湿性心脏病合并冠心病的同期外科治疗,提高手术效果。方法回顾性分析9例患者同期施行冠状动脉旁路移植术和心脏瓣膜手术的临床资料及远期随访资料,其中二尖瓣置换6例,二尖瓣成形2例,主动脉置换1例。合并冠状动脉单支病变中7例用左乳内动脉做血管桥,二支病变中1例用左乳内动脉加大隐静脉做血管桥,1例用左乳内动脉加左桡动脉做血管桥。结果术后平均呼吸机辅助时间19h,平均重症监护室监护时间2.6天,出院前行超声检查心功能,射血分数上升0%～20%。发生呼吸功能不全3例,严重心律失常3例,出血再次开胸1例,经治疗均好转。心绞痛不同程度消失,无围手术期死亡,远期随访心功能明显改善。结论积极、正确的围手术期处理,改善心功能,尽量缩短主动脉阻断时间,术中心肌保护良好,是提高瓣膜病合并冠心病患者手术成功率、降低死亡率、减少并发症的关键。

Aim To review the experience of the combined coronary artery by pass grafting (CABG) and cardiac valve operations of rheumatic heart disease (RHD). Methods There were mitral valve lesion in 8 patients,aortic valve lesion in 1, and one-coronary vessel disease in 7, two-coronary vessel disease in 2. Opertions include mitral valvo plasty in 2 patients, mitral valve replacement in 9 and aortic valve replacement in 1. The one-graft was present concomitantly in 7 patients, two-graft in 2. Results There were no hospital postoperative mortality. 9 patients were followed up from 3 to 32 months. Angina disappeared in 7 of 9 patients. Conclusions CABG and cardiac valve operation should be performed concomitantly when coronary artery diseases and cardiac valvular disease present simultaneously. To strength the myocardial protection, shortening of myocardial ischemic time are the important measures to improve the operation effects.