外科治疗冠心病合并缺血性二尖瓣反流的疗效及围术期并发症的影响因素分析

Curative effect of surgical treatment on coronary heart disease complicated by ischemic mitral regurgitation and influence factors of perioperative complications

目的探讨单纯冠状动脉旁路移植术(CABG)或CABG+二尖瓣成形术(MVP)联合治疗冠心病合并缺血性二尖瓣反流(IMR)的疗效以及影响围术期并发症的相关因素。方法收集2017年9月~2020年9月于郑州市第七人民医院心血管外科接受外科治疗的215例冠心病合并中度IMR患者的临床资料。根据手术方法不同分为CABG组(n=124)和CABG+MVP组(n=91)。记录并比较两组患者围手术期指标以及术后超声心动图检查项目包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)等。根据术后是否发生并发症或死亡,分为无并发症组(n=179)和并发症组(n=36)。记录并比较患者手术时间、是否行主动脉内球囊反搏(IABP)辅助、移植血管数、平均远端吻合口、远端吻合口分布、ICU时间、机械通气时间、住院时间等围手术期指标。采用单因素和多因素Logistic回归分析对影响患者围术期并发症的相关因素进行分析。结果CABG+MVP组手术时间、住院时间、LVEF、LVESd均高于CABG组,二尖瓣反流面积低于CABG组(P<0.05);CABG+MVP组死亡4例(3.23%),CABG组死亡2例(2.20%)。CABG+MVP组和CABG组发生并发症例数(低心排综合征、脑血管事件、二次开胸、二次气管插管、术后感染、肾功能衰竭)和死亡例数相比,差异均无统计学意义(P>0.05);无并发症组和并发症组患者在年龄、既往心肌梗死史、合并症、术前肌酐值、IABP辅助、LVEF相比,差异均有统计学意义(P<0.05);年龄、既往心肌梗死史、合并症、LVEF是影响冠心病合并中度IMR患者围术期并发症的独立因素(P<0.05)。结论CABG联合MVP治疗冠心病合并中度IMR临床疗效较好,术后患者心脏功能得到明显改善,未增加围术期并发症和死亡率,为临床治疗策略的选择提供参考依据。对于相对高龄、既往有心肌梗死史、合并症和低LVEF患者应引起临床医师的重视。

Objective To investigate the curative effects of coronary artery bypass grafting(CABG)or CABG combined with mitral valvuloplasty(MVP)on coronary heart disease(CHD)complicated by ischemic mitral regurgitation(IMR),and discuss the related factors influencing on perioperative complications.Methods The clinical materials were collected from 215 patients with CHD complicated by moderate IMR in Department of Cardiovascular Surgery of the Seventh People’s Hospital of Zhengzhou City from Sept.2017 to Sept.2020.All patients were divided,according to surgical methods,into CABG group(n=124)and CABG+MVP group(n=91).The perioperative indexes and postoperative echocardiography items were recorded and compared including left ventricular ejection fraction(LVEF),left ventricular end-diastolic inner diameter(LVEDd)and left ventricular end-systolic diameter(LVESd).According to whether postoperative complications and death occurred or not,the patients were divided into non-complication group(n=179)and complication group(n=36).The perioperative indexes were recorded and compared including surgical time,whether or not having assistance of intra-aortic balloon pumps(IABP),number of grafted vessels,mean distal anastomosis,distal anastomosis distribution,ICU time,mechanical ventilation time and length of hospital stay.The related factors influencing perioperative complications were analyzed by using single-factor and multi-factor Logistic regression analysis.Results The surgical time,length of hospital stay,LVEF and LVESd were higher,and tricuspid regurgitation in area(TRA)was lower in CABG+MVP group than those in CABG group(P<0.05).There were 4(3.23%)death cases in CABG+MVP group and 2(2.20%)in CABG group.The differences in cases of complications(low cardiac output syndrome,cerebrovascular events,secondary thoracotomy,secondary tracheal intubation,postoperative infection and renal failure)and death cases had no statistical significance between CABG+MVP group and CABG group(P>0.05).The differences in age,past myocardial infarction history,complications,preoperative creatinine value,IABP assistance and LVEF had statistical significance between non-complication group and complication group(P<0.05).Age,past myocardial infarction history,complications and LVEF were independent factors influencing perioperative complications in patients with CHD complicated by moderate IMR(P<0.05).Conclusion CABG combined with MVP has a good clinical efficacy in the treatment of CHD combined by moderate IMR.The heart function has been significantly improved without increasing perioperative complications and mortality in patients after surgery.It provides a reference for the selection of clinical treatment strategies.Clinicians should pay attention to patients with higher age,past myocardial infarction history,complications and low LVEF.