黄小伟
HUANG Xiaowei

• 1:无锡明慈心血管病医院心外科

摘要(Abstract)：

目的:探讨冠状动脉旁路移植并同期瓣膜置换对冠心病并心脏瓣膜病患者的疗效。方法:将58例冠心病并心脏瓣膜病患者根据手术方案分为对照组(n=33)及实验组(n=25),实验组采用冠状动脉旁路移植并同期瓣膜置换术治疗,对照组采用非同期冠状动脉旁路移植和期瓣膜置换术治疗,术后随访6个月;记录两组患者术后呼吸机辅助通气、ICU停留和出院时间,统计永久性起搏器植入率、瓣周漏发生率及死亡率,检测手术前后两组患者静脉血中内皮素(ET)、一氧化氮(NO)、肌酸激酶(CK)和乳酸脱氢酶(LDH)水平,检测两组患者的心胸比、左室收缩末期内径(LVESD)和左室舒张末期内径(LVEDD)和左室功能(LVEF)等左心功能指标,并比较术后并发症发生率。结果:实验组术后呼吸机辅助通气时间、ICU停留时间及住院时间较对照组缩短(P<0.01);随访期间,实验组瓣周漏发生率低于对照组(P<0.05);与术前比较,术后1周2组患者静脉血中ET-1、CK和LDH含量明显降低,NO明显升高(P<0.01),但组间比较,差异无统计学意义(P>0.05);术后1周及6个月,实验组LVEDD、LVESD低于对照组,LVEF高于对照组(P<0.05);术后实验组总并发症发生率低于对照组(P<0.05)。结论:与非同期手术相比,冠心病并心脏瓣膜病患者应用冠状动脉旁路移植并同期瓣膜置换术可更有效地改善心脏功能、降低并发症发生率。
Objective: To investigate the effect of coronary artery bypass grafts and simultaneous valve replacement in patients with coronary heart disease and heart valve disease( patients of C&V).Methods: Fifty-eight patients of C&V were selected and divided into control group( group C,n = 33)and experimental group( group E,n = 25). Patients in group E were treated with coronary artery bypass grafts and valve replacement in the same period,while patients in group C were treated with nonsynchronous surgery. All of the patients were followed up for 6 months after operation. The operationrelated indexes and complications of the 2 groups were observed and compared,and the vascular endothelial function,myocardial zymogram and cardiac function before and after operation in the 2 groups were detected and compared. The incidence of adverse events during follow-up were recorded and compared. Results: The duration of ventilator assisted ventilation,ICU stay and hospital stay in group E were significantly shorter than those in group C( P < 0. 01). During follow-up,the valvular leakage incidence in group E was lower than that in group C( P < 0. 05). The levels of ET-1,CK,LDH of the2 groups in 1 week after operation were significantly lower than those before operation,while NO level was increased than before( P < 0. 01),but there was no significant difference between the 2 groups( P > 0. 05). In 1 week and in 6 months after operation,levels of LVEDD and LVESD in group E were lower than those in group C,while LVEF and FS were higher than those in group C( P < 0. 05 or P <0. 01). The incidence of postoperative complication in group E was significantly lower than that in group C( P < 0. 05). Conclusions: Coronary artery bypass grafts plus synchronized valve replacement in treatment of patients of C&V can effectively improve their cardiac function,and decrease complication incidence,compared with no-synchronized operation.

关键词(KeyWords)： 冠状动脉疾病;心脏瓣膜疾病;冠状动脉旁路移植;同期手术;内皮素;肌酸激酶;心脏功能实验;瓣膜置换
coronary heart disease;valvular heart disease;coronary artery bypass grafts;simultaneous operation;endothelin;creatine kinase;cardiac function experiment;valve replacement

Abstract:

Keywords:

基金项目(Foundation): 江苏省省医药卫生科研项目(1502000320)

作者(Author): 黄小伟
HUANG Xiaowei

DOI: 10.19367/j.cnki.1000-2707.2018.07.023

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