摘要
目的探讨冠状动脉粥样硬化性心脏病伴中度以上缺血性二尖瓣反流经外科治疗后的早期疗效。方法回顾性分析1999年12月-2010年12月行冠状动脉旁路移植术(CABG)治疗的175例冠心病合并中度以上缺血性二尖瓣反流患者的临床资料,根据手术方式分为单纯CABG组(108例)、CABG同期行二尖瓣成形/置换组(同期手术组,67例)。比较两组的年龄、性别、搭桥支数、主动脉内球囊反搏(IABP)和心室辅助装置(VAD)使用情况、围术期死亡率、同时行其他手术(主动脉瓣置换、室壁瘤切除、室间隔缺损修补等)情况,并分析两组手术前后左房内径(LA)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)、二尖瓣反流程度、肺动脉收缩压(sPAP)、心功能NYHA分级等的变化。结果两组年龄、性别、搭桥支数、使用IABP和VAD、围术期死亡率、同时行其他手术情况差异均无统计学意义(P>0.05)。两组术后LA、LVEDD、二尖瓣反流程度、sPAP、心功能NYHA分级等均较术前明显改善(P<0.01),而LVEF与术前比较差异无统计学意义(P>0.05)。结论对于冠心病伴中度以上缺血性二尖瓣反流患者,全面而积极的手术干预并未带来更理想的早期手术效果;在充分再血管化的基础上,可选择简单而安全有效的手术方式。
Objective To probe into the early effect of surgical treatment in coronary atherosclerotic heart disease（CAD） patients with moderate-to-severe ischemic mitral regurgitation（IMR）.Methods A total of 175 CAD patients with moderate-to-severe IMR undergoing coronary artery bypass grafting（CABG） from December 1999 to December 2010 were analyzed retrospectively.Based on the method applied during surgery,108 patients were assigned to CABG group,undergoing CABG alone,and 67 to CABG＋MVP/R group,undergoing CABG plus concomitant mitral valvuloplasty/repair（MVP/R）.Differences between groups were compared in age,gender,numbers of the conduits,application of intra-aortic balloon pump（IABP） and ventricular assist device（VAD）,perioperative mortality,and other concomitant procedures（i.e.aortic valve replacement,resection of the heart wall aneurysm,repair of the septal defect repair）.Differences within the groups were looked for in terms of left atrial diameter（LA）,left ventricular ending diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF）,mitral regurgitation degree,systolic pulmonary artery pressure（sPAP）,and cardiac function（NYHA classification）,pre-operatively and post-operatively.Results The differences between the groups showed no statistical significance in terms of age,gender,numbers of conduits,application of IABP and VAD,peri-operative mortality,and concomitant procedures（P0.05）.LA,LVEDD,mitral regurgitation,sPAP,and cardiac function（NYHA classification） after operation were improved obviously in both groups compared with that before operation（P0.01）.There was no statistical significance in LVEF before and after operation（P0.05）.Conclusions The comprehensive and aggressive surgery did not result in more ideal early effect to CAD patients with moderate-to-severe IMR.Based on the total revascularization,we can choose simpler,safer,and more effective surgical methods.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2012年第4期332-336,共5页
Medical Journal of Chinese People's Liberation Army
关键词
冠状动脉分流术
二尖瓣闭锁不全
心血管外科手术
coronary artery bypass
mitral valve insufficiency
cardiovascular surgical procedures
