同期施行瓣膜和冠状动脉手术的临床特点

Clinical Features of Valve and Coronary Artery Surgery Performed Synchronously

目的：探讨同期施行瓣膜和冠状动脉手术的临床特点。方法：总结16例冠状动脉旁路移植（CABG）同期行心脏瓣膜手术患者的临床资料，与同期20例单独行冠状动脉旁路移植术的患者进行比较。结果：同期施行瓣膜和冠状动脉手术组术前左房内径、左室舒张末期内径及左室收缩末期内径显著增大；术后辅助呼吸时间、低心排出量综合征、心律失常、肺及神经系统并发症发生率高于单独行冠状动脉旁路移植术组（P〈0．05）。结论：虽然同期施行瓣膜和冠状动脉手术使操作更为复杂，手术时间和心肌缺血时间延长可加重侵入性操作损伤，但通过术前充分评估病情，设计合理的手术方案，正确的围手术期处理，同样可以达到良好的效果。

Objective：To explore the clinical features of valve and coronary artery surgery performed synchronously. Methods ：The clinical data of 16 patients who accepted the valve and coronary artery surgery synchronously was summarized, and compared with that of 20 patients only underwent coronary artery bypass graft. Resuits：Before the operations, these patients＇ left atrial diameter, inner diameters of left ventricle during end-diastole and end-systole were significantly increased;after the operations, the duration of ventilatory support, the incidence vates of low ventricular stroke output syndrome, arhythmia, and complications of lung and nervous system were langer and higher, compared to the parameters of the patients who only underwent coronary artery bypass graft （ P 〈 0.05 ）. Conclusions ： Although performing valve and coronary artery surgery synchronously may makes the procedure more complex, and the extension of operating time and exacerbation of myocardial ischemia would aggravate the operating injuries. However, the satisfactory results can still be achieved by sufficiently evaluating the pathogenetic conditions before surgery, and devising a rational operative schedule, and correctly dealing with the conditions concerning operation.