冠状动脉粥样硬化合并心脏瓣膜病临床治疗观察

Clinical observation of coronary atherosclerosis combined with valvular heart disease

目的总结心脏瓣膜病合并冠状动脉粥样硬化患者在行瓣膜置换的同时行冠状动脉搭桥的手术方法及临床治疗效果。方法回顾并分析本院2013年2月至2017年1月116例施行此类手术患者术后相关心脏功能状态指标和并发症情况。结果术后复查心脏彩超，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。同期行冠状动脉搭桥、二尖瓣置换、三尖瓣成形46例，冠状动脉搭桥、二尖瓣成形31例，冠状动脉搭桥、主动脉瓣置换30例，冠状动脉搭桥、二尖瓣联合主动脉瓣置换9例。术后并发低心排综合征10例、脑梗死5例，二次开胸止血5例，急性肾功能衰竭7例，3例因出现多器官功能衰竭死亡，1例因突发脑出血死亡。结论对高危疑难的心脏瓣膜病合并冠状动脉狭窄超过50％以上的患者，应该同期行冠状动脉搭桥及心脏瓣膜成形术或瓣膜置换术。术前积极综合治疗改善心肺功能，术中合理的心肌保护和减少体外循环时间，可有效降低死亡率及并发症，提高手术治疗效果。

Objective To explore the method and clinical effect of coronary artery bypass grafting and heart valve surgery in patients with valvular heart disease complicated with coronary heart disease, and to summarize the clinical data. Methods We retrospectively analyzed the postoperative cardiac function status and complication of 116 patients in our hospital from February 2013 to January 2017. Results The postoperative heart ultrasonography was performed. The results showed that the valve function was good and the cardiac function was im- proved. The left ventricular ejection fraction was significantly improved compared with that before operation. At the same time, coronary artery bypass grafting, mitral valve replacement, tricuspid valve formation in 46 cases, coro- nary artery bypass grafting, mitral valve formation in 31 cases, coronary artery bypass grafting, aortic valve re- placement in 30 cases, coronary artery bypass, mitral valve combined with aorta valve replacement in 9 cases. There were 10 cases of low cardiac output syndrome, 5 cases of cerebral infarction, 5 cases of secondary thoracic hemostasis, 7 cases of acute renal failure, 3 cases of multiple organ failure and 1 death due to sudden cerebral hemorrhage. Conclusion Coronary artery bypass grafting and valvuloplasty or valvular replacement surgery should be performed in patients with high-risk heart valve disease with coronary artery disease with more than 50% coronary artery stenosis. Preoperative comprehensive treatment to improve heart and lung function, intraoperative my- ocardial protection and reduce the time of cardiopulmonary bypass can effectively reduce mortality and complica- tions, improve the surgical treatment.