老年患者同期行心脏瓣膜置换和冠状动脉搭桥术的临床研究

Clinical analysis of cardiac valve replacement conducted simultan eously with coronary artery bypass grafting for elderly patients

目的总结老年患者同期行心脏瓣膜置换和冠状动脉搭桥术的临床特点和围术期处理经验。方法回顾性分析2013年1月至2015年1月同期行瓣膜置换和冠状动脉搭桥术治疗的37例65岁以上老年患者的临床资料。结果 37例患者共搭桥74支,其中乳内动脉31支,大隐静脉43支。瓣膜病变中,二尖瓣合并三尖瓣病变19例,主动脉瓣病变3例,二尖瓣合并主动脉瓣合并三尖瓣病变15例。行主动脉瓣置换术3例,二尖瓣置换+三尖瓣成形术16例,二尖瓣置换+主动脉瓣置换+三尖瓣成形术18例。术后死亡2例,1例死于低心排综合征死亡,1例死于肝功能衰竭。术后主要并发症:急性肾功能不全5例,术后二次开胸止血1例,胸骨愈合不良1例,恶性心律失常1例,脑梗塞1例,治疗后均痊愈出院。术后1、3、6、12月患者左室舒张末内径均较术前显著缩小(均P<0.05);自术后3月起患者左心室射血分数(EF)较术前显著增加(均P<0.05)。结论细致的围术期管理是老年患者同期行心脏瓣膜置换和冠状动脉搭桥术成功及术后顺利恢复的关键。

Objective To understand the surgical characteristics of coronary artery bypass grafting conducted simuhan eously with valve replacement and to develop insights into the perioperative work. Method A retrospective review was performed into the clinical data of 37 patients of over 65 years of age who were admitted to the hospital during the period from January 2013 to January 2015 and were subjected to coronary artery bypass grafting conducted together with cardiac valve replacement. Findings 74 grafts were performed which included 31 artery grafts and 43 vein grafts. Of the 37 patients of heart valve diseases, 19 had mitral valve lesion complicated with tricuspid valve lesions, 3 had aortic valve lesion, and 15 had muhivalve lesion. 3 patients underwent coronary artery bypass grafting and aortic valve replacement （ CABG ＋ AVR） surgeries. 16 had coronary artery bypass grafting, mitral valve replacement and tricuspid valvoplasty（C） ABG ＋ MVR ＋ TVP surgeries. The other 18 patients received coronary artery bypass grafting, double valve replacement, and tricuspid valvoplasty （C） ABG ＋ DVR ＋ TVP surgeries. The surgeries resulted in two deaths. One died of low cardiac outputsyndrome and the other of liver failure. Postoperative complications included one case of reoperation for stanching blood flow, 5 cases of renal failure, 1 case of sternal dehiscence, 1 case of malignant arrhythmia, and 1 case of cerebral infarction. All the patients with complications were treated and ended up in successful recovery. At 1,3, 6 and 12 months after surgery, the patients obtained less LVEDD as compared with before surgery （P 〈 0.05）. At 3, 6 and 12 months after surgery, the patients obtained favorable LVEF （P 〈 0.05）. Conclusion Meticulous perioperative management plays a crucial role in the process of recovery of elderly patients undergoing surgeries of coronary artery bypass grafting conducted simuhan eously with valve replacement.