CAJ | 학술논문

目的：总结瓣膜手术同期行冠状动脉旁路移植术的体会。方法2009年5月-2014年6月我科住院患者共35例患者，男28例，女7例；年龄45岁-68岁（62±4.67岁）；入院心功能分级（NYHA）Ⅱ级17例，Ⅲ级11例，Ⅲ-Ⅳ级7例；冠脉造影均提示冠状动脉病变。中度低温体外循环心脏停跳下行手术治疗，先行桥血管远端吻合及乳内吻合，再行瓣膜成形术或置换术；静脉桥血管近端吻合在主动脉开放后完成。组内患者行二尖瓣机械瓣置换术6例，生物瓣置换术6例；二尖瓣机械瓣膜置换术+三尖瓣成形术7例，二尖瓣生物瓣膜置换术+三尖瓣成形术8例；主动脉瓣机械瓣膜置换1例、生物瓣置换术1例；二尖瓣成形2例；二尖瓣成形+三尖瓣成形1例；二尖瓣机械瓣置换+主动脉瓣机械瓣置换+三尖瓣成形3例。桥血管数量：1根28例；2根4例；3根1例；4根2例。结果围手术期死亡1例，ICU停留时间2-17d（3.28±2.83d），住院时间11-34d（19.4±4.61d）。结论冠状动脉旁路移植术同期行瓣膜手术效果确切、安全可靠。
목적：총결판막수술동기행관상동맥방로이식술적체회。방법2009년5월-2014년6월아과주원환자공35례환자，남28례，녀7례；년령45세-68세（62±4.67세）；입원심공능분급（NYHA）Ⅱ급17례，Ⅲ급11례，Ⅲ-Ⅳ급7례；관맥조영균제시관상동맥병변。중도저온체외순배심장정도하행수술치료，선행교혈관원단문합급유내문합，재행판막성형술혹치환술；정맥교혈관근단문합재주동맥개방후완성。조내환자행이첨판궤계판치환술6례，생물판치환술6례；이첨판궤계판막치환술+삼첨판성형술7례，이첨판생물판막치환술+삼첨판성형술8례；주동맥판궤계판막치환1례、생물판치환술1례；이첨판성형2례；이첨판성형+삼첨판성형1례；이첨판궤계판치환+주동맥판궤계판치환+삼첨판성형3례。교혈관수량：1근28례；2근4례；3근1례；4근2례。결과위수술기사망1례，ICU정류시간2-17d（3.28±2.83d），주원시간11-34d（19.4±4.61d）。결론관상동맥방로이식술동기행판막수술효과학절、안전가고。
Objective To summarize the experience of combined valve operation and coronary artery bypass grafting. Methods A total of 35 patients hospitalized in our department have been investigated from May 2009 to June 2014 B ,including 28 cases male,7 cases female,age range of 45-68 years (62±4.67 years),heart function classification (NYHA):grade II 17 cases,gradeⅢ11 cases,gradeⅢ-Ⅳ 7 cases. All cases have been diagnosed by coronary angiography. Cardiac operations have been performed under moderate hypothermic cardiopulmonary bypass. Vascular anastomosis and/or the bridge internal mammary anastomosis have been operated first,then revalvuloplasty or replacement has been performed;vein grafts in the proximal anastomosis have been achieved after aortic opening. Within the group of patients,6 cases underwent mechanical mitral valve replacement,6 cases under-went bioprosthetic mitral valve replacement;7 cases underwent mitral valve replacement plus three tricuspid valve plasty;8 cases underwent mitral bioprosthetic replacement plus three tricuspid valve plasty;1 cases underwent mechanical aortic valve replace-ment,1 cases underwent biological valve replacement;two tip 2 cases underwent mitral valvuloplasty;1case underwent two tricus-pid plus three tricuspid annuloplasty;3 cases underwent mitral valve replacement plus aortic valve replacement plus three tricus-pid annuloplasty. Bridge vessel number is listed as follows:1 of 28 cases;2 of 4 cases;3 of 1 case;4 of 2 cases. Results There was no operative death but one case of perioperative death among the 35 patients. cases of all patients had no operation death ,Total heart ICU monitoring time in all patients was 2-17 days (3.28 ±2.83 days). Hospitalization Total hospitalization time was 11-34days(19.4±4.61 days). Conclusion Coronary artery bypass grafting is effective,safe and reliable operation of valve.