46例心脏瓣膜病合并冠心病同期手术的临床疗效分析

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1、授予单位代码10089学号或申请号20153242中国图书分类号R541.4+R542.5HebeiMedicalUniversity硕士学位论文专业学位46例心脏瓣膜病合并冠心病同期手术的临床疗效分析研究生：张国利导师：陈子英教授专业：外科学二级学院：河北医科大学第二医院2018年3月目录中文摘要························································································1英文摘要································

2、························································2英文缩写························································································4研究论文46例心脏瓣膜病合并冠心病同期手术的临床疗效分析前言························································································5材料与方法·

3、···········································································5结果······················································································7附表······················································································8讨论···················

4、···································································11结论······················································································17参考文献··············································································17综述心脏瓣膜病合并冠心病同期手术的围手术期处理·········

5、···················21致谢······························································································33个人简历·······················································································34中文摘要46例心脏瓣膜病合并冠心病同期手术的临床疗效分析摘要目的：探讨心脏瓣膜病合并冠心病同期手术治疗的临床效果，总结临床经验

6、。方法：回顾性分析2016年1月-2017年12月在我院心脏外科同期行心脏瓣膜病合并冠心病手术治疗的患者共46例，期间行单纯冠状动脉旁路移植术的患者共858例（死亡率为1%）。其中男性患者28例（60.8%），女性患者18（39.2%）例；平均年龄（59.4±7.3）岁；平均住院天数（30.7±9.0）天；体外循环时间（159.7±50.1）min；主动脉的阻断时间为（93.6±35.1）min；辅助循环时间（56.0±25.3）min；重症监护室时间（3.8±2.4）天；呼吸机辅助时间（1.8±1.3）天；通过观察患者的临床资料，比较术前、术

7、中、术后相关指标变化及术后并发症发生情况。结果：通过对本组患者术前和术后1周超声心动图数据的收集，归纳，总结，进行统计学分析。左心室射血分数（LVEF，leftventricularejectionfraction）与术前相比无统计学意义，左心室舒张末期内径（LVEDD，leftventricularend-diastolicdimension）与术前相比，有较好的改善，存在差异性，具有统计学意义（P<0.05）。术后出现并发症共10例，其中肺部感染有4例，切口愈合不良有1例，神经系统并发症有1例，恶性心律失常2例，多器官功能衰竭1例，低心排综

8、合征1例。本组死亡患者4例，死亡率为8.6%。结论：1.心脏瓣膜病合并冠心病，病情较复杂，是一种高危疾病。2.心脏瓣膜病合并冠心病同期手术治疗，与单一