外科治疗瓣膜病变合并冠心病临床分析

发布时间：2018-11-10 18:53

【摘要】：目的分析瓣膜病变合并冠心病患者同期手术治疗方法及其效果。方法 40例瓣膜病变合并冠心病患者心脏停跳后先行冠状动脉旁路移植术,采用大隐静脉依次对回旋支、钝缘支、对角支、后降支行序贯或端端吻合。再行瓣膜替换或成形,之后完成乳内动脉与前降支吻合,再同期完成主动脉瓣替换与二尖瓣替换/成形术,最后再行三尖瓣成形术。结果手术时间(378.56±91.95)min,主动脉阻断时间(105.49±33.99)min,体外循环时间(159.10±46.09)min,机械通气时间(32.18±34.66)h,24h心包纵隔引流量(469.49±407.01)mL。出院后随访1~48个月,患者心前区不适、胸闷、胸痛、活动后乏力、双下肢水肿等症状消失。结论施行瓣膜替换/成形联合冠状动脉旁路移植术是治疗瓣膜病变合并冠心病的有效方法。
[Abstract]:Objective to analyze the simultaneous surgical treatment of valvular disease complicated with coronary heart disease (CHD). Methods Coronary artery bypass grafting was performed in 40 patients with valvular disease complicated with coronary heart disease after cardiac arrest. The circumflex branch, blunt marginal branch, diagonal branch and descending branch of great saphenous vein were followed by sequential or end-to-end anastomosis. The internal mammary artery was anastomosed with the anterior descending branch, the aortic valve replacement and mitral valve replacement / plasty were completed at the same time, and tricuspid valvuloplasty was performed. Results the operative time was (378.56 卤91.95) min, aortic occlusion time (105.49 卤33.99) min, cardiopulmonary bypass time (159.10 卤46.09) min, mechanical ventilation time (32.18 卤34.66) h. 24 h pericardial mediastinal drainage (469.49 卤407.01) mL. The patients were followed up for 1 ~ 48 months. The symptoms of anterior area discomfort, chest tightness, chest pain, fatigue after exercise and edema of both lower limbs disappeared. Conclusion valvular replacement / angioplasty combined with coronary artery bypass grafting is an effective method for the treatment of valvular disease with coronary heart disease.
【作者单位】：南昌大学第一附属医院心脏大血管外科;
【基金】：江西省教育厅科学技术研究重点项目(赣教技字200769) 江西省科技计划项目(20121BBG70027)
【分类号】：R654.2

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