摘要目的:探讨心脏瓣膜手术同期冠状动脉旁路手术治疗冠心病合并瓣膜病的临床效果。方法:选择浙江绿城心血管病医院2014年1月至2018年1月收治的冠心病合并心脏瓣膜病患者60例开展前瞻性研究，根据随机数字表法分为两组(30例/组)，观察组同期实施心脏瓣膜手术、冠状动脉旁路移植术，而对照组先行心脏瓣膜手术，再间隔实施冠状动脉旁路移植术，比较术后恢复情况、心功能指标、生活质量评分、术后并发症发生率。结果:(1)观察组的术后重症监护室(ICU)监护时间[(5.29±1.04)d]、机械通气持续时间[(3.95±0.98)d]、住院时间[(13.59±2.84)d]均较对照组缩短( t＝4.205、4.015、3.997，均 P<0.05)。(2)治疗后，观察组的左室射血分数[(49.36±6.25)%]、每搏输出量[(76.29±5.31)mL]均较对照组更高( t＝4.066、4.093，均 P<0.05)，其脑钠肽水平[(378.32±27.82)ng/L]较对照组更低( t＝4.152， P<0.05)。(3)治疗后，观察组的生理健康、心理健康、生活环境、社会关系等评分分别为(89.47±8.69)分、(84.49±8.21)分、(88.16±9.24)分、(85.46±8.95)分，均较对照组更高( t＝4.139、3.753、3.859、4.389，均 P<0.05)。(4)观察组、对照组术后并发症总发生率分别为3.33%(1/30)、20.00%(6/30)，观察组较对照组更低(χ 2＝4.043， P<0.05)。 结论:同期实施心脏瓣膜手术、冠状动脉旁路移植术可减少冠心病合并心脏瓣膜病患者的术后并发症，有利于加快其术后恢复速度，更好地改善其心功能和生活质量。

abstractsObjective:To investigate the clinical effect of simultaneous heart valve surgery and coronary artery bypass surgery in the treatment of coronary heart disease with valvular disease.Methods:From January 2014 to January 2018, 60 patients with coronary heart disease and valvular heart disease who admitted to Zhejiang Lyucheng Cardiovascular Hospital were selected in the prospective study.According to the random number table method, they were randomly divided into two groups, with 30 cases in each group.The observation group underwent heart valve surgery and coronary artery bypass grafting at the same time, while the control group underwent heart valve surgery first and then coronary artery bypass grafting at intervals.The recovery after operation, cardiac function index, quality of life score and incidence of complications after operation were compared.Results:(1)The ICU monitoring time[(5.29±1.04)d], duration of mechanical ventilation[(3.95±0.98)d] and hospitalization time[(13.59±2.84)d] in the observation group were shorter than those in the control group( t=4.205, 4.015, 3.997, all P<0.05). (2) After treatment, the left ventricular ejection fraction[(49.36±6.25)%] and stroke output[(76.29±5.31)mL] of the observation group were higher than those of the control group ( t=4.066, 4.093, all P<0.05), and the level of brain natriuretic peptide[(378.32±27.82)ng/L] was lower than that of the control group ( t=4.152, P<0.05). (3) After treatment, the scores of physical health, mental health, living environment and social relations in the observation group were (89.47±8.69)points, (84.49±8.21)points, (88.16±9.24)points and (85.46±8.95)points, respectively, which were higher than those in the control group ( t=4.139, 3.753, 3.859, 4.389, all P<0.05). (4)The total incidence of postoperative complications in the observation group was 3.33%(1/30), which was lower than 20.00%(6/30) in the control group (χ 2=4.043, P<0.05). Conclusion:Simultaneous heart valve surgery and coronary artery bypass grafting can reduce the postoperative complications of patients with coronary heart disease and heart valvular disease, accelerate the recovery rate and improve the heart function and quality of life.