重症心脏瓣膜病的外科治疗  

Surgery treatment of severe cardiac valve diseases

作　　者：张万青[1] 苏廷宝[1] 程可洛[1] 张光休[1] 何悦概[1] 陈捷[1] 黄一东[1] 

机构地区：[1]广东医学院附属医院胸心外科,广东湛江524001

出　　处：《中国基层医药》2005年第9期1161-1162,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的总结重症心脏瓣膜患者围术期处理及外科手术经验,提高患者的治愈率。方法回顾性研究1999年9月至2004年10月外科治疗78例重症心脏瓣膜患者的围术期处理、术中心肌保护及术中手术方法。结果78例中75例治愈;发生并发症13例:低心排综合征5例、活动性出血二次开胸止血3例、脑栓塞2例、迟发性心脏破裂1例、肾功能不全1例、肺部感染1例,其中死亡3例。结论加强围术期处理,采用冷温血心肌保护液,选择双叶瓣、保留左房室瓣瓣下结构或左房室瓣后瓣及瓣下结构,延长辅助呼吸时间,重症心脏瓣膜病亦可取得良好的手术效果。Objective In order to improve the cure rate of surgery treatment of severe cardiac valve diseases. Methods A retrospective study was carried out review experience. 78 cases of severe cardiac valve diseases receivered the cardiac valve replacement from September 1999 to October 2004. Their perioperative management and myocardial protection and operation were reviewed. Results 62 cases were recovered well. Coplication were seen in 16 cases：low-heart output sydrome in 5, re-operation for mediastinal hemorrhage in 3. cerebral infarction in 2,delayed-heart corruption in 1, renal insufficiency in 1, pulmoanary infection in 1,3 of 16 cases were death. Conclusion Perioperative management and myocardial protection are emphasized. Warm blood-oxgenative myocardioplegia solution is carried out. Bileaflets mechanical heart valve is used in patients with huge hearts and small left ventricular in way of retention of left atrioventricular tendon and papillary muscle. Assistant respiration is longed after operation. The patients with severe valve diseases recovery well at eary-staged period.

关 键 词：心脏瓣膜疾病 心脏瓣膜假体植入 心脏外科手术 重症心脏瓣膜病 外科治疗 温血心肌保护液 后瓣及瓣下结构 围术期处理 迟发性心脏破裂 低心排综合征 二次开胸止血 左房室瓣 

分 类 号：R654.2[医药卫生—外科学] R542.2[医药卫生—临床医学]