130例重症瓣膜置换术的治疗体会  

Experience of valve replacement in 130 cases

作　　者：姜海明[1] 王得坤[1] 梁毅[1] 郑俊猛[1] 李健英[1] 

机构地区：[1]广东省中山市人民医院心胸外科,中山市528403

出　　处：《岭南心血管病杂志》2000年第4期240-241,共2页South China Journal of Cardiovascular Diseases

摘　　要：目的　总结 130例重症心脏瓣膜置换术的治疗体会。方法　 130例重症瓣膜置换术中 ,男性 73例 ,女性5 7例 ,年龄 2 0～ 6 2岁 ,平均 45岁。心功能Ⅲ级 83例 ,Ⅳ级 47例 ,均在全麻中低温体外循环下手术。术前均进行强心、利尿、扩血管药物、营养支持和高压氧等治疗。在置换二尖瓣时均保留其部分大瓣及其主腱索和全部小瓣及其瓣下结构 ,细小主动脉根部替换主动脉瓣时 ,先采用切开无冠瓣替换 ,失败后可经右冠状动脉开口左侧切开主动脉瓣环 ,右室流出道及室间隔扩大主动脉瓣环 ,再用涤纶片或人工血管修复室间隔 ,右室流出道 ,能够充分扩大主动脉瓣环以置换人工瓣。结果　全组病人有 117例心脏自动复跳 ,13例电击除颤复跳 ,4例出现顽固性低心排死亡。 1例死于凝血机制障碍致创面广泛大出血 ,死亡率 4% (5 /130 ) ,余均治愈出院。结论　重症心脏瓣膜病变者 ,特别是联合瓣膜病变 ,术前心功能均较差 ,应重视围术期处理 ,主动脉瓣环过小 ,可采用扩大瓣环方法 ,在置换二尖瓣时 ,保留二尖瓣瓣下结构。合并中度或以上三尖瓣关闭不全患者应行Devega环缩术。Objective To summarize the experience of valve replacement for rheumatic valvular disease. Methods 130 patients with rheumatic valvular disease underwent valve replacement. There were 37 males and 57 females. The ages varied from 20 to 62 years, mean 45 years. Preoperative heart function (NYHA) was graded as class Ⅲ in 83 cases, class Ⅳ in 47 cases. General anesthesia and shallow hypothermic circulatory arrest was employed in all cases. Myocardial protection was completed with warm blood induction and intermittent cold crystal cardioplegia. Results The heart beat spontaneously resumed to sinus rhythm in 117 cases and the others resumed to sinus rhythm by lightning stroke defibrillation. 2 patients died of refractory low cardiac output. 1 patient died of extensive oozing and bleeding. The rest were discharged. Conclusions To obtain good result, the following should be considers: ① perioperative treatments are very important for the patients with poor heart function who undergo double valve replacement. ② Reserve the subvalvular structure of mitral valve. ③ Devega annuloplasty should be done for middle degree to severe tricuspid incompetence.

关 键 词：瓣膜置换 瓣下结构 Devega环缩术 

分 类 号：R54[医药卫生—心血管疾病]