重症心脏瓣膜病围术期的处理  

Surgical treatment of serious valve disease

作　　者：王志伟[1] 姬尚义[1] 计乐群[1] 谭敏[1] 陈长春[1] 杨建安[1] 陈伟新[1] 

机构地区：[1]广东深圳市孙逸仙心血管医院心外科,518020

出　　处：《中国基层医药》2004年第6期645-646,共2页Chinese Journal of Primary Medicine and Pharmacy

基　　金：.NULL.

摘　　要：目的　总结 180例重症心脏瓣膜病围术期处理的经验 ,探讨提高重症心脏瓣膜病早期生存率的措施。方法　自 1993年 9月至 2 0 0 2年 12月 ,为 180例重症心脏瓣膜病病人施行瓣膜置换术 ,占同期瓣膜置换手术 2 7%。男 81例 ,女 99例 ;年龄 15～ 6 6岁 ,平均 4 2 4 5± 13 38岁。其中风湿性心脏病 174例。左房室瓣病变者 81例 (合并主动脉病变者 93例 )。其中对 4 7例合并中度以上右房室瓣关闭不全的病例进行同期右房室瓣成形术 ,对 17例巨大左房进行左心房折叠术 ,有 39例部分或全部保留左房室瓣装置。结果　本组术后并发低心输出量综合征 (低心排 ) 8例 ,严重心律失常 12例 ,早期死亡 9例 ,死亡率 5 %。结论　对重症心脏瓣膜病例 ,注意围术期各环节处理 ,即重视术前心功能改善 ,恰当选择手术时机 ,术中加强心肌保护 ,合理纠正病变 ,术后严密监护 ,可提高手术成功率。Objective To summarize the surgical treatment results of 180 cases of serious heart valve diseases and investigate the treatment to improve the early-term survival.Methods From September 1993 to September 2002,we underwent valve replacement operations on 180 patients who suffered serious heart valve diseases,which were about 27% of total valve replacement cases in our hospital in the same time.There were 81 males and 99 females,the mean age was 42.45±13.38 years old(the range is 15～66 years old).174 patients were afflicted with rheumatic heart disease,in which there were 81 cases of mitral disease(involved 94 cases of mitral along with aortic valve disease).The 47 cases with tricuspid valve incompetence were underwent tricuspid valvuloplasty.The 17 cases with giant left atrium were underwent plication of the left atrium.The 39 cases of mitral replacement adopted the preservation methods(partial or total preservation of papillary muscles and chordae tendineae).Results In this group,8 cases had postoperative low cardiac output syndrome and 12 cases had serious arrhythmias.9 cases were hospital death(5%).Conclusions To improve the outcome of operation,must pay much attention to perioperative management,the proper operative time,myocardial protection,surgical methods and intensive care.

关 键 词：重症心脏瓣膜病 围手术期 外科治疗 生存率 瓣膜置换术 

分 类 号：R654.2[医药卫生—外科学]