摘要
目的总结1003例心脏瓣膜置换手术病例临床特点及围手术期处理经验。方法手术在体外循环中度低温下进行，其中单纯二尖瓣置换术（MVR）555例，主动脉瓣及二尖瓣置换术（BVR）273例，主动脉瓣置换术（AVR）139例，三尖瓣置换术（TVR）26例，三瓣置换术10例。全组病人按≤40岁、41—59岁、≥60岁分为3组，分别为152、572、279例。结果975例（97．2％）恢复出院，死亡28例（2．8％）。3组死亡率分别为3．3％，1．7％，4．7％。死因分别为呼吸循环衰竭11例、多脏器功能衰竭10例、室性心律失常5例、肾功能衰竭2例。发生各种并发症74例次。结论瓣膜置换术是治疗瓣膜病变的有效手段，选择适当的手术时机，改进和完善体外循环技术，加强术中心肌保护，不断改进和提高手术技巧，尽量保留瓣下结构的二尖瓣置换术，能减少瓣膜置换术的手术风险，提高手术疗效。主动脉瓣置换时应尽量去除钙化的瓣叶，置入大一号的瓣膜，减少跨瓣压差，有利于左室重构。术中应常规探查三尖瓣，对瓣环明显扩大的病人予以三尖瓣成形术。心脏大的病人尤应注意围术期电解质的变化，防止发生恶性心律失常。生物瓣的术后抗凝较机械瓣方便，并发症也少，应提高生物瓣的应用比例。围手术期处理得当，可减少术后并发症及降低病死率，老年病人术前合并症多、病情重，应加强围手术期监护。
Objective To review the experience of 1 003 cases heart valve replacement operations from August 1997 to July 2005. Methods All 1 003 cases were underwent heart valve replacement under hypothermia and CPB, MVR 555 cases, BVR 273 cases, AVR 139 cases, TVR 26 cases, both BVR and TVR 10 cases. All cases were divided into three groups according to age≤40 years,40 - 60 years, 960 years, respectively. Results 975 cases （97.2% of all cases） recovered and discharged. There were 75 postoperative complicafions, including 28 deaths （mortality of 2.8%）. The mortality rate of three groups was 3.3%, 1.7% and 4.7%, respectively. The major causes of early death were ventricular arrhythmia, respiratory, circulatory failure, renal failure and multiple organ failure, respectively. Conclusion Valve replacement is an effective remedy for valve disease. Operative complication and mortality rate can be significantly decreased by correct perioperative management. Eider patients have mere combinations and their illness is more serious. More attention should be paid perioperative management.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2007年第1期15-17,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏瓣膜疾病
心脏瓣膜假体植入
围手术期医护
Heart valve diseases Heart valve prosthesis implantation Perioperative care
