标题：同期行冠状动脉旁路移植和心脏瓣膜置换术的体外循环管理

      作者：李美霞 1，田 毅 1，林 巍 2，卢 伟 2
    (海口市人民医院麻醉科 1、心胸外科 2，海南 海口 570208)

      卷次： 2013年24卷18期

      【摘要】 目的 评价冠状动脉旁路移植(CABG)同期行心脏瓣膜置换术的体外循环(ECC)管理效果。
方法 回顾性分析28例CABG同期行瓣膜置换术患者的ECC时间、升主动脉阻断时间、开放升主动脉后心脏自
动复跳、术后恢复等情况，用美国纽约心脏病协会(NYHA)分级标准评价术后心脏功能疗效。结果 患者ECC转
流时间平均为(121±67)分，阻断升主动脉时间平均为(102±46)分，心脏自动复跳率为89.2%(25/28)，术后治愈率为
89.2%(25/28)，21例随访15个月，心脏功能改善总有效率为90.5%，术后心绞痛持续时间和发作频率分别比术前
减少了72.8%和76.3% (P<0.01)，超声心动图复查左心室射血分数、左心室短轴缩短分数、心脏指数分别比术前增
加16.7%、24.1%、30.2% (P<0.05)。结论 手术治疗效果很好，术前改善心功能，术中体外循环管理和术后严密监
护是关键。

      【关键词】 冠状动脉旁路移植术；心脏瓣膜置换术；体外循环；管理

      【中图分类号】 R654.2 【文献标识码】 A 【文章编号】 1003—6350（2013）18—2676—03


Management of extracorporeal circulation on patient received the coronary artery bypass grafting and cardiac valve
replacement surgery simultaneously.
LI Mei-xia 1, TIAN Yi 1, LIN Wei 2, LU Wei 2. Department of Anesthesiology 1, Department
of Cardiothoracic Surgery 2, Haikou People's Hospital, Haikou 570208, Hainan, CHINA

【Abstract】 Objective To assess the management experiences of extracorporeal circulation (ECC) on pa-
tients who had received coronary artery bypass grafting (CABG) and cardiac valve replacement surgery simultaneous-
ly. Methods From July 2008 to July 2011, the clinical data, including duration of extracorporeal circulation,
cross-clamping time of ascending aorta, results after opening the aorta clamp hearts automatic rebeated and postopera-
tive recovery, were analyzed in all the 28 patients treated by CABG and cardiac valve replacement surgery simultane-
ously in our hospital. The postoperative heart function was evaluated with grading standards of United States New
York Heart Association (NYHA). Results The mean bypass time of ECC was (121±67) minutes, and the mean time
of blocking the ascending aorta was (102±46) minutes. The rate of spontaneous return of heartbeat was 89.2% (25/28),
and the postoperative cure rate was 89.2% (25/28). Twenty-one patients were followed up for 15 months, and the total
effective rate of improved cardiac function was 90.5%. Duration and the seizure frequency of the postoperative clini-
cal symptoms of angina pectoris were 72.8% and 76.3% lower than preoperative (P<0.01). Echocardiography showed
that the ejection fraction, minor axis shortening fraction, cardiac index of left ventricular after surgery were 16.7%,
24.1%, 30.2% more than before surgery, respectively (P<0.05). Conclusion Coronary artery bypass grafting and car-
diac valve replacement surgery have good treatment results. Improving function before operation, managing extracor-
poreal circulation and monitoring closely postoperatively can improve the success rate of surgery.

      【Key words】 Coronary artery bypass grafting; Cardiac valve replacement; Extracorporeal circulation; Management