冠状动脉旁路移植同期行心脏瓣膜手术的临床研究(附57例报告)

Clinic study of coronary artery bypass grafting combined with cardic valve operation (report of 57 cases)

目的：介绍同期施行冠状动脉旁路移植术和瓣膜手术的体会。方法：2000年12月至2006年3月，57例冠状动脉旁路移植术同期行瓣膜手术，患者年龄43～81岁，平均60．5岁，术前心功能（NYHA）Ⅱ级19例，Ⅲ级31例，Ⅳ级7例；二尖瓣病变29例，主动脉病变13例，联合瓣膜病变15例，瓣膜病病因中，风湿性31例，退行性13例，缺血性9例，二瓣化畸形4例。共搭桥103支，平均1．8支，根据患者的年龄及病变血管情况选用乳内动脉、桡动脉及大隐静脉做血管桥。行二尖瓣成形17例，二尖瓣置换12例；主动脉瓣成形10例，主动脉瓣置换12例，二尖瓣和主动脉瓣双瓣置换术6例，同时行三尖瓣成形13例。术中放置经食管超声监测检测瓣膜成形效果。结果：术后早期死亡3例；术后并发症为出血、低心排出量综合征、肾功能不全、肺部感染和小面积脑梗塞。术后6个月复查心脏彩超，瓣膜成形效果满意；术后随访平均13．5个月，无明显心绞痛复发，心功能改善。结论：风湿性瓣膜病患者，有冠心病高危因素的患者，术前应常规行冠状动脉造影检查。缺血性二尖瓣关闭不全患者行瓣膜成形，手术效果满意。综合使用多种成形技术行主动脉瓣成形，取得较好的近中期效果。术中经食管超声检测并结合注水试验对于了解成形术的效果有重要意义。充分的术前准备，恰当地使用主动脉内球囊反搏（IABP）及床旁血滤可提高手术成功率。

Objective：To evaluate the outcome of coronary artery bypass gaffing （CABG） combined with cardic valve operation. Method：From 2000 to 2006, fifty-seven patients underwent CABG combined with concomitant valve operation .The mean age of the patients was 60.5 years（43 to 81 years） .Heart function was Class Ⅱ （NYHA）in 19 patients,Class Ⅲ in 31 ,Class Ⅳ in 7. Mitral valves replacement in 12 patients, aortic valves replacement in 12 patients,mitral valves and aortic valves replacement in 6 patients. 17 cases of mitral valves and 10 cases of aortic valves were repaired. 13 cases of tricuspid valves were repaired in this group. The total number of grafts was 103 .The average number of grafts was 1.8. The results were evaluated by transesophagea echocardiography and saline injection test. Result：There were 3 patients who died of low cardiac output syndrome and mulfiorgan failure respectively. The results of valvoplasty were satisfied 6 months after operation. 54 paients were followed up from 3 months to 2 years, angina disappeared and associated with improved heart function. Conclusion： For patients with rheumatic valvular heart disease, older than 50 years, or have high risk factor for iscbemic heart disease, coronary angiography is necessary. The results of valvoplasty for ischemic mitral valve regurgitation were satisfied. The results of using some different skills to repair aortic valves were satisfied. The transesophagea echocardiography and saline injection test should be used during the operations, Efficient preoperative management and properly using IABP and bemodialysis are the important measures to improve the operation effects.