70岁以上患者同期行冠状动脉旁路移植术与心脏瓣膜手术的临床分析

摘要

Objective To summarize the experience with combined coronary artery bypass grafting (CABG) and cardiac valve surgery in patients aged over 70 years. Methods Twenty-two patients aged over 70 years who underwent combined CABG and cardiac valve surgery were included in this study. Of these patients,8 underwent aortic valve replacement(AVR) ,3 mitral valve replace-ment(MVR),2 MVR and AVR.5 mitral valve plasty(MVP) ,2 MVP and tricuspid valve plasty (TVP) ,1 AVR and TVP.l MVR and TVP. A total of 67 bypass grafts were transplanted with a mean ofl ?(3. 1 + 1.7) grats. Results No perioperative death ccurred in the patients. The stay time of patients in ICU was 59?63(91. 6?5. 9)h,the ventilation time of patients was 12 ?96 (43. 8?6. l)h,and the hospital stay time of patients was 15 ?44(21. 3?. 2)d after operation. The inner diameter of left ventricle at the end-diastolic phase was significantly smaller while the LVEF was significantly higher after operation than before operation(50. 5 + 7. 7 mm vs 56. 5?10.2 mm,P<0. 01;52. 6% ?0. 6% vs 47. 9% ?0. 2%, P<0. 05). The patients were followed up for 6?2 months after operation,during which 2 patients died. Conclusion Combined CABG and cardiac valve surgery is an effective procedure for elderly patients with coronary artery and valvular heart disease. Intensive perioperative management,proper treatment of valvular diseases, sufficient myocardial revascularization,excellent myocardial protection and shortening myocardial ischemic time are the key factors for successful operation.%目的 总结70岁以上患者同期冠状动脉旁路移植术(CABG)与心脏瓣膜手术的经验.方法 选择70岁以上患者同期实施冠状动脉旁路移植术与心脏瓣膜手术患者22例.主动脉瓣置换8例,二尖瓣置换3例,二尖瓣和主动脉瓣双瓣置换2例,二尖瓣成形5例,二尖瓣加三尖瓣成形2例,主动脉瓣置换加二尖瓣成形1例,二尖瓣置换三尖瓣整形1例.共旁路移植67支,平均1～5(3.1±1.7)支.结果 本组围手术期无死亡.重症监护室滞留时间59～163(91.6±35.9)h,机械通气时间12～96(43.8±26.1)h,术后住院时间15～44(21.3±9.2)d.左心室舒张末内径较术前明显降低[(50.5±7.7)mm vs (56.5±10.2) mm,P＜0.01)],LVEF较术前明显升高[(52.6±10.6)％vs(47.9±10.2)％,P＜0.05].术后随访6个月～1年,死亡2例.结论 老年患者同期施行CABG与心脏瓣膜手术效果满意.加强围手术期管理、恰当处理瓣膜病变、心肌充分再血管化、良好心肌保护和缩短心肌缺血时间是手术成功的关键因素.