心脏瓣膜病置换术同期行冠状动脉搭桥术116例临床分析

Clinical analysis of 116 cases of heart valve replacement with coronary artery bypass grafting

目的探讨心脏瓣膜病合并冠心病患者同期行心脏瓣膜手术及冠状动脉搭桥的方法及临床效果。方法回顾性分析2013年2月—2017年1月海南省人民医院心脏外科施行心脏瓣膜病置换术同期行冠状动脉搭桥手术患者116例,分析术后相关心脏功能状态指标及相关并发症情况。结果同期行二尖瓣置换、三尖瓣成形术、冠状动脉搭桥46例;二尖瓣成形术、冠状动脉搭桥31例;主动脉瓣置换术、冠状动脉搭桥30例;二尖瓣联合主动脉瓣置换术、冠状动脉搭桥9例,术后复查心脏彩色超声,结果显示瓣膜功能良好,心功能明显改善,左室射血分数较术前明显好转;术后并发低心排出量综合征(低心排)10例,2次开胸止血5例,急性肾功能衰竭7例,脑梗死5例:因出现多器官功能衰竭(MOF)死亡3例,因突发脑出血死亡1例。结论对高危老年心脏瓣膜病合并严重冠心病(冠状动脉血管超过50%以上狭窄)的患者,应该行心脏瓣膜手术治疗同期冠状动脉搭桥、手术前积极治疗改善心肺功能,术中合理的心肌保护,减少体外循环时间,可有效降低病死率以及并发症,提高手术的治疗效果。

Objective To investigate the methods and clinical effects of heart valve surgery and coronary artery bypass grafting in patients with heart valve disease complicated with coronary heart disease.Methods A retrospective study was conducted in 116 patients who underwent surgery in our hospital from February 2013 to January 2017.The postoperative correlation analysis of cardiac function status and postoperative complications were collected.Results The cardiac function was improved and the left ventricular ejection fraction （LVEF） was significantly improved compared with that before operation.Coronary artery bypass grafting, mitral valve replacement, tricuspid valve replacement were performed in 46 patients.Coronary artery bypass graft, mitral valvuloplasty in 31 cases;coronary artery bypass, aortic valve replacement in 30 cases;coronary artery bypass, mitral valve and aortic valve replacement in 9 cases, 10 cases were found with postoperative low cardiac output syndrome, thoracotomy in 5 cases, acute renal failure in 7 cases, 5 cases of cerebral infarction, 3 cases of multiple organ failure（MOF） and death, 1 case of sudden death due to cerebral hemorrhage.Conclusion In patients with coronary heart disease with high risk of coronary heart disease, more than 50% of coronary artery stenosis should be performed concurrently with coronary artery bypass grafting and heart valve surgery, and active treatment to improve cardiopulmonary function, intraoperative myocardial protection reasonable to reduce the cardiopulmonary bypass time, it can effectively reduce mortality and complications, improve the surgical treatment.