摘要
目的 探讨同期施行冠状动脉旁路移植术和瓣膜手术的方法、疗效及影响因素。方法 回顾分析 1995～ 1998年间 15例冠状动脉旁路移植术时 ,同期行二尖瓣置换或成形、主动脉瓣置换、联合瓣膜置换、Bentall术。结果 瓣膜病病因中 ,风湿性 8例 ,退行性 4例 ,缺血性 3例。手术病死率为 6 7%(1/ 15 ) ;4例发生低心输出量综合征 ,其中 3例需行主动脉内球囊反搏 ;5例二尖瓣成形术后 ,反流面积从6 5～ 15 0cm2 降至 0～ 2 0cm2 (P <0 0 5 ) ;术后生存病人心功能明显改善。结论 对于风湿性瓣膜病病人 ,年龄超过 5 0岁或有心绞痛症状者 ,需行冠状动脉造影检查 ;乳头肌慢性缺血所致二尖瓣关闭不全病人的心功能较差 ,但大多数仍可行二尖瓣成形术纠正 ,尽管手术难度大 ,但手术的近、远期疗效良好。
Objective To evaluate the outcome of coronary artery bypass grafting (CABG) combined with valve surgery. Methods During 1995(1998, fifteen cases of CABG combined with mitral valve replacement/repair, aortic valve replacement or Bentall operation were studied retrospectively. Results The operative mortality was 6.7%. Low cardiac output syndrome occurred in 4 cases who were preoperatively in NYHA class IV, and three of them needed intraaortic balloon pump support. After mitral valveplasty, the area of mitral regurgitation was reduced from (8.6±4.5) cm to (0.5±1.0) cm. The survivors remained in good conditions during a period of 2～30 months follow-up. Conclusion For patients with rheumatic valve disease who are older than 50 or complain of chest pain coronary arteriography is necessary before surgery. Most ischemic mitral regurgitation may be corrected by mitral annuloplasty. Those with severe left ventricular dysfunction will be benefited greatly from surgery.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2000年第2期74-76,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
冠状动脉旁路移植术
心脏瓣膜手术
心肌保护
Coronary artery bypass grafting Heart valve surgery Myocardial protection
