CABG联合MVR治疗老年冠心病合并中重度功能性二尖瓣反流效果分析

Analysis of effect of coronary artery bypass grafting combined with mitral valve replacement in the treatment of elderly patients with coronary heart disease complicated with moderate and severe functional mitral regurgitation

摘要:

目的 比较分析老年冠状动脉粥样硬化性心脏病（以下简称冠心病）合并中重度功能性二尖瓣反流患者行单纯冠状动脉旁路移植术（CABG）和CABG联合二尖瓣置换术（MVR）的临床疗效。方法 选取2009年6月—2018年4月徐州医科大学附属淮安医院诊治的老年冠心病合并中重度功能性二尖瓣反流患者106例作为研究对象。根据手术方式将其分为CABG组和CABG+MVR组，分别于术前及术后1年检查患者左室射血分数、左心室舒张末期内径和二尖瓣反流面积，评估纽约心脏病协会（NYHA）心功能分级改善情况，并记录患者住院时间、ICU时间、体外循环时间等手术指标。结果 CABG+MVR组术中体外循环时间、升主动脉阻断时间及术后ICU时间与CABG组比较，差异有统计学意义（P?<0.05），CABG+MVR组时间较长；IABP使用比例、住院时间和围手术期病死率比较，差异无统计学意义（P?>0.05）；两组患者术后1年较术前：左室舒张末期内径和二尖瓣反流面积减小，左室射血分数增加，NYHA心功能分级明显改善（P?<0.05）。结论 老年冠心病合并中重度功能性二尖瓣反流患者行CABG+MVR手术可改善患者心功能，提高生活质量，具有临床疗效佳、安全性好等优点。

Abstract:

Objective To analyze and compare the clinical effects of coronary artery bypass grafting (CABG) and CABG combined with mitral valve replacement (MVR) in patients with coronary heart disease complicated with moderate and severe functional mitral regurgitation. Methods From June 2009 to April 2018, 106 elderly patients with coronary heart disease complicated with moderate and severe functional mitral regurgitation were divided into CABG group and CABG+MVR group. Left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and mitral regurgitation area were examined before and after operation. The improvement of NYHA grade was evaluated, and the duration of hospitalization, ICU and cardiopulmonary bypass were recorded. Results The intraoperative cardiopulmonary bypass time, ascending aortic clamping time and postoperative ICU time in CABG?+?MVR group were significantly longer than those in CABG group (P??0.05). One year after operation, the mitral regurgitation area and left ventricular end diastolic diameter decreased, left ventricular ejection fraction increased and NYHA cardiac function grade improved significantly in CABG group and CABG?+?MVR group (P?