冠心病和瓣膜病同期手术患者临床特征分析

Analysis of the clinical characters among patients undergoing coronary artery bypass grafting and valve replacement at corresponding period

目的分析冠状动脉粥样硬化性心脏病((冠心病)和瓣膜病合并存在,需同期手术患者的临床特征。方法回顾性分析深圳市孙逸仙心血管医院同期行冠状动脉旁路移植术和瓣膜置换手术患者40例的临床资料。患者分为两组,其中以冠心病入院,合并瓣膜病者设为A组(n=19),以瓣膜病为主,合并冠心病者设为B组(n=21),对比分析两组患者的临床资料。结果 A组患者的年龄、心绞痛症状、主动脉瓣狭窄、左主干病变、冠状动脉三支病变的发生率及冠状动脉旁路移植术数均明显高于B组,差异有统计学意义(P<0.05);A组患者心房纤颤、二尖瓣病变、冠状动脉单支病变的发生率明显低于B组,差异有统计学意义(P<0.05);两组患者的体质量、心功能Ⅳ级、陈旧心肌梗死、主动脉阻断时间、体外循环时间、呼吸机时间、重症监护病房时间比较,差异无统计学意义(P>0.05)。结论冠心病合并瓣膜病患者和瓣膜病合并冠心病患者的临床特征是不同的,术前明确冠心病和瓣膜病复合存在的情况,可提高冠状动脉旁路移植和瓣膜置换同期手术的手术成功率。

Objectives To summarize the characters of patients undergoing coronary artery bypass grafting （CABG） and valve replacement （VR） at corresponding period. Methods Forty patients undergoing CABG and VR in Sun Yat- sen Cardiovascular Hospital were divided into two groups. Group A included 19 patients who primarily suffered from the coronary heart disease and company with the cardiac valve disease. Group B included 21 patients who primarily suffered from the cardiac valve disease and company with the coronary heart disease. The contrastive analysis of the clinical data was done between two groups. Results The patients＇ age and the incidence of unstable angina, aortic valve stenosis, left coronary artery stenosis, multiplex stenosis of coronary artery and the grafts of group A were obviously greater than those of group B（P〈0.05）. The incidences of atrial fibrillation, mitral valve disease and single coronary artery stenosis of group A was obviously lower than those of group B（P〈0.05）. The difference had no statistical significance on weight, incidence of New York heart assosiation （NYHA） IV, old myocardial infarction, time of aorta clamped, extracorporeal circulation, respirator used and intensive care unit stayed between the two groups （P〉0.05）. Conclusions The clinical characters of the patients primarily suffered from the coronary heart disease and company with the cardiac valve disease is different from who primarily suffered from the cardiac valve disease and company with the coronary heart disease. It is important to improve the success ratio of CABG and VR at corresponding period that we find out the coexistence of the coronary heart disease and valve disease before operation.