摘要
报道２９例合并巨大左室（舒张末容积指数≥１８０ｍｌ／ｍ２）的主动脉瓣病变患者主动脉瓣替换术（ＡＶＲ）的围术期处理经验。其中男２８例、女１例。主动脉瓣关闭不全２７例、关闭不全＋狭窄２例。心功能Ⅱ级４例、Ⅲ级１４例、Ⅳ级１１例。单纯ＡＶＲ１６例、ＡＶＲ＋二尖瓣成形术或室缺修补术或升主动脉替换术１１例，Ｂｅｎ－ｔａｌ手术２例。结果显示，术中、术后早期并发症主要有频发室早（２７．５８％）、室颤（１０．３４％），低心排综合征（１３．７９％）和多脏器功能衰竭（１７．２４％）。早期死亡３例（室颤２例、心肺肾功能衰竭１例），早期病死率为１０．３４％。作者认为，这类手术的围术期处理重点是防治室性心律失常，保护和改善心肺功能以及防治多脏器功能衰竭。
The experiences of perioperative management were reported in 29 (male 28 and female 1) patients with giant left ventricle (endodiastolic volume index≥180 ml/m 2) undergoing aortic valve replacement (AVR), among whom 27 had aortic valvular incompetence and 2 with combined aortic valvular lesions. Heart function was rated class Ⅱ in 4 patients, class Ⅲ in 14, and class Ⅳ in 11, preoperatively. AVR was performed in 16 patients, combined AVR with other procedures, including mitral valvuloplasty or ventricular septal defect repair or ascending aorta replacement, in 11, and Bentall operation in 2 patients. The results showed that the main operative complications were ventricular premature beat (27.58%), ventricular fibrillation(10.34%),low cardiac output syndrome (13.79%) and multiple organ failure (17.24%). Three patients died during or after operation with an operative mortality of 10.34%. In view of the occurrence of these complications, we consider that the emphasis of perioperative management for this kind of operation must be put on the protection of the heart and lung function, the prevention and treatment of ventricular arrhythmia and multiple organ failure.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
1999年第4期256-258,共3页
Medical Journal of Chinese People's Liberation Army
关键词
主动脉瓣病变
并发症
巨大心室
瓣膜替换术
aortic valve replacement
giant ventricle, left
perioperative management
