冠状动脉旁路移植同期行二尖瓣手术治疗缺血性心脏病合并二尖瓣中度反流临床研究

Clinical study of coronary artery bypass graft for ischemic heart disease complicated with mitral regurgitation by mitral valve surgery

目的探讨冠状动脉旁路移植术(Coronary artery bypass graft,CABG)同期行二尖瓣手术治疗缺血性心脏病合并二尖瓣中度反流的可行性与有效性。方法选取2013年11月—2016年4月南阳医学高等专科学校第一附属医院61例缺血性心脏病合并二尖瓣中度反流患者,均于完善相关检查后给予CABG同期行二尖瓣手术治疗。统计本组手术一般情况、术后重症监护室(Intensive care unit,ICU)入住时间及并发症发生情况,并对比手术前及术后6个月左室舒张末期内径(Left ventricular end diastolic diameter,LVEDD)、左房内径(Left atrial diameterLAD)、左室射血分数(Left ventricular ejection fraction,LVEF)、二尖瓣反流面积及生存质量评分。结果本组61例患者手术均取得成功,无1死亡病例,平均每位患者搭桥(1.82±0.73)支;主动脉阻断时间57~171(93.57±21.36)min,心肺转流时间79~180(124.69±17.63)min,术后ICU停留时间26~53(32.58±6.47)h;术后并发症发生率为6.56%(4/61);术后6个月,LVEDD、LAD及二尖瓣反流面积较术前明显减小,LVEF及生存质量评分较术前显著提高,差异有统计学意义(P<0.05)。结论缺血性心脏病合并二尖瓣中度反流CABG同期行二尖瓣手术治疗,有利于早期二尖瓣功能,促进缺血心肌实现完全再血管化,且具有一定安全性,可有效改善患者术后生存质量。

Objective To investigate the feasibility and efficacy of coronary artery bypass graft（ CABG） in the treatment of ischemic heart disease complicated with mitral regurgitation by mitral valve surgery. Methods From January 2013 to April 2016,selected 61 patients with ischemic heart disease complicated with mitral regurgitation in the first affiliated hospital of Nanyang medical college were treated with CABG concurrent mitral valve surgery after improve the relevant inspection. Surgery general condition,postoperative intensive care unit（ ICU） check-in time and complications were statistically analyzed between the two groups,and left ventricular end diastolic diameter（ LVEDD）,left atrial diameter LAD,left ventricular ejection fraction（ LVEF）,mitral regurgitation Flow area and quality of life score were compared before and 6 months after surgery. Results The surgery of 61 patients in this group were successful,no cases of death,on average,each patient was bridged（ 1. 82 ± 0. 73） roots; The aortic occlusion time was 57 - 171（ 93. 57 ±21. 36） min,the cardiopulmonary bypass time was 79 - 180（ 124. 69 ± 17. 63） min,the postoperative ICU stay time was 26 - 53（ 32. 58 ± 6. 47） h; The incidence of postoperative complications was 6. 56%（ 4/61）; At 6 months after operation,LVEDD,LAD and mitral regurgitation area were significantly lower than those before operation,and LVEF and quality of life were significantly higher than those before operation（ P〈0. 05）. Conclusion Treatment of ischemic heart disease complicated with mitral regurgitation using CABG with mitral valve surgery is beneficial to early correction of mitral valve function and promote complete revascularization of ischemic myocardium,with some safety,and ffectively improve the quality of life after surgery.