冠心病合并中度缺血性二尖瓣反流患者临床特征分析

Clinical features of coronary heart disease complicated with moderate ischemic mitral regurgitation

目的探讨冠心病合并中度缺血性二尖瓣反流患者的临床特征、手术治疗及围术期并发症。方法回顾性分析822例冠心病合并中度缺血性二尖瓣反流患者的临床资料。结果 822例患者中3支血管病变460例(56.0%);688例(83.7%)接受不停跳单纯冠状动脉搭桥术,62例(7.5%)接受停跳下单纯冠状动脉搭桥术,72例(8.8%)接受冠状动脉搭桥+二尖瓣成形术。术后二尖瓣反流面积[(2.2±1.2)cm^2]、左心室舒张末期内径[(50.1±7.0)mm]、左心室收缩末期内径[(36.4±7.8)mm]小于术前[(5.9±1.3)cm^2、(54.1±7.0)mm、(39.0±8.0)mm](P<0.05),左室射血分数[(50.4±10.8)%]高于术前[(49.6±10.1)%](P<0.05)。术后住院期间发生主要不良心脑血管事件51例(6.2%);全因性死亡42例(5.1%),其中接受单纯冠状动脉搭桥术者39例(5.2%),接受冠状动脉搭桥+二尖瓣成形术者3例(4.2%);术后发生心肌梗死18例(2.2%),心力衰竭40例(4.9%),脑血管事件4例(0.5%),肝功能不全34例(4.1%),肾功能不全36例(4.4%),主动脉球囊反搏支持141例(17.1%),体外膜肺支持14例(1.7%),二次开胸27例(3.3%),二次气管插管40例(4.9%),胸骨哆开1例(0.1%),肾功能不全36例(4.3%)。随访1.7~9.8(4.3±1.8)年,失访60例(7.7%),随访期间全因性死亡84例(11.7%),发生心肌梗死23例(3.2%)、心力衰竭52例(7.2%)、脑血管事件21例(2.9%)。结论冠心病合并中度缺血性二尖瓣反流患者心功能较差,病情较重,围术期并发症发生率较高。

Objective To investigate the clinical features and perioperative complications of coronary heart disease with moderate ischemic mitral regurgitation.Methods The clinical data of 822 patients with coronary heart disease and moderate ischemic mitral regurgitation undergoing surgical treatment were retrospectively analyzed.Results Among 822 patients,460(56.0%)had triple vessel lesions;688(83.7%)received off-pump coronany antery bypass grafing(CABG),62(7.5%)received on-pump CABG,and 72 patients(8.8%)underwent CABG+mitral valve plasty.The postoperative mitral regurgitation area was smaller than that before surgery((2.2±1.2)cm^2 vs.(5.9±1.3)cm^2)(P<0.05),left ventricular end-diastolic dimension and left ventricular end-systolic dimension were shorter than those before surgery((50.1±7.0)mm vs.(54.1±7.0)mm;(36.4±7.8)mm vs.(39.0±8.0)mm)(P<0.05),and the left ventricular ejection fraction was higher than that before surgery((50.4±10.8)%vs.(49.6±10.1)%)(P<0.05).The incidence of major adverse cerebrovascular events during postoperative hospitalization occurred in 51 patients(6.2%),and all-cause death occurred in 42(5.1%)including 39(5.2%)dying in CABG and 3(4.2%)dying in CABG+mitral valve plasty.The postoperative hospitalization complications included myocardial infarction in 18 patients(2.2%),heart failure in 40(4.9%),cerebrovascular events in 4(0.5%),hepatic insufficiency in 34(4.1%),renal insufficiency in 36(4.4%),intra-aortic balloon pump in 141(17.1%),extracorporeal membrane oxygenation support in 14(1.7%),secondary thoracotomy in 27(3.3%),secondary endotracheal intubation in 40(4.9%),and sternotomy in 1(0.1%).Totally 720 patients(92.3%)were followed up for 1.7 to 9.8(4.3±1.8)years,and 60 patients(7.7%)were lost,showing 84 patients(11.7%)with all-cause deaths,23(3.2%)with myocardial infarction,52(7.2%)with heart failure,and 21(2.9%)with cerebrovascular events.Conclusion The patients with coronary heart disease combined with moderate ischemic mitral regurgitation have poor cardiac function,serious condition,and high incidence of perioperative complications.