摘要
目的:探讨同期进行冠状动脉旁路移植术(CABG)与心脏瓣膜置换术(HVR)对冠心病合并心脏瓣膜病变患者ICU停留时间、心功能及远期预后的影响。方法:选择我院收治的94例冠心病合并心脏瓣膜病变患者为研究对象,随机均分为CABG与HVR非同期治疗组和同期治疗组,每组47例,对比两组患者术后心功能、术中术后相关指标及5年内生存率,不良反应发生率。结果:术后与非同期治疗组比较,同期治疗组LVEF [(44.23±11.03)%比(49.58±11.39)%]、左心室舒张早期峰值流速比舒张晚期峰值流速(E/A)[(0.87±0.09)比(0.94±0.12)]明显提高,左房内径(LAD)[(39.47±10.16)mm比(34.46±8.72)mm]、左室舒张末期内径(LVEDd)[(58.49±10.65)mm比(53.17±9.13)mm]、左室收缩末期内径(LVESd)[(48.69±8.73)mm比(42.07±8.36)mm]、心胸比(CTR)[(0.66±0.14)比(0.54±0.09)]明显减小,心功能Ⅱ级比例(46.81%比70.21%)明显增加,Ⅲ级比例(34.04%比12.77%)明显降低,升主动脉阻断时间、体外循环时间、呼吸机辅助时间、ICU停留时间、住院时间均明显缩短(P<0.05或<0.01)。5年后随访,与非同期治疗组比较,同期治疗组心血管不良事件发生率(40.43%比19.15%)明显降低,5年生存率(44.68%比68.08%)明显升高(P均<0.05)。结论:冠心病合并心脏瓣膜病变患者同期行CABG与HVR能够显著缩短ICU停留时间等术后观察指标,改善心功能,提高远期生存率,减少不良事件率。
Objective:To explore influence of simultaneous coronary artery bypass grafting(CABG)and heart valve replacement(HVR)therapy on ICU stay time,cardiac function and long-term prognosis in patients with coronary heart disease(CHD)complicated heart valve disease(HVD).Methods:A total of94CHD+HVD patients were selected from our hospital.They were randomly and equally divided into non-simultaneous treatment group(NST group)and simultaneous treatment group(ST group),according received CABG and HVR simultaneously.Postoperative cardiac function,related indexes during and after operation,survival rate within five years and incidence rate of adverse reactions were compared between two groups.Results:Compared with NST group after operation,there were significant rise in LVEF[(44.23±11.03)%vs.(49.58±11.39)%],left ventricular early diastolic peak flow velocity/late diastolic peak flow velocity(E/A)[(0.87±0.09)vs.(0.94±0.12)]and percentage of NYHA classⅡ(46.81%vs.70.21%),and significant reductions in left atrial diameter(LAD)[(39.47±10.16)mm vs.(34.46±8.72)mm],left ventricular end-diastolic dimension(LVEDd)[(58.49±10.65)mm vs.(53.17±9.13)mm],left ventricular end-systolic dimension(LVESd)[(48.69±8.73)mm vs.(42.07±8.36)mm],cardiothoracic ratio(CTR)[(0.66±0.14)vs.(0.54±0.09)],percentage of NYHA classⅢ(34.04%vs.12.77%),ascending aorta block time,extracorporeal circulation time,ventilator assist time,ICU stay and hospitalization time in ST group,P<0.05or<0.01.Compared with NST group after five-year follow-up,there was significant reduction in incidence rate of major adverse cardiovascular events(40.43%vs.19.15%),and significant rise in five-year survival rate(44.68%vs.68.08%)in ST group,P<0.05both.Conclusion:Simultaneous CABG and HVR can significantly shorten ICU stay time etc.postoperative observation index,improve cardiac function and long-term survival rate,reduce incidence rate of adverse reactions in CHD+HVD patients.
作者
郑春和
曲楠
ZHENG Chun-he;QU Nan(Department of Critical Care Medicine, Third People's Hospital of Huizhou City, Huizhou, Guangdong, 516000, China)
出处
《心血管康复医学杂志》
CAS
2018年第6期679-683,共5页
Chinese Journal of Cardiovascular Rehabilitation Medicine
