二尖瓣闭式扩张术后瓣膜置换术临床分析  

Clinical analyze of heart valve replacement after closed mitral commissurotomy

作　　者：刘晓强[1] 梅举[1] 张宝仁[1] 徐志云[1] 邹良健[1] 

机构地区：[1]第二军医大学附属上海长海医院心胸外科

出　　处：《中国心血管病研究》2006年第1期28-30,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的总结二尖瓣闭式扩张术后瓣膜置换术的经验及提高治疗效果的措施。方法分析上海长海医院自2001年8月至2002年7月二尖瓣闭式扩张术后瓣膜置换术34例,二尖瓣闭式扩张术至瓣膜置换术间隔平均时间为4～29(12.5±6.73)年。其中,二尖瓣置换术2例(5.9%),二尖瓣置换+三尖瓣成形术16例(47.1%),二尖瓣置换+主动脉瓣置换术2例(5.9%),二尖瓣、主动脉瓣双瓣置换+三尖瓣成形术14例(41.2%)。并与同期风湿性心脏病瓣膜置换术患者有关临床资料对照分析。结果二尖瓣闭式扩张术后瓣膜置换术患者与同期风湿性心脏病瓣膜置换术患者在性别、年龄、心功能、手术方式、体外循环时间、主动脉阻断时间以及手术后早期死亡率等方面比较差异无统计学意义。结论对二尖瓣闭式扩张术后复发或病情加重的患者应尽早行瓣膜置换,加强围手术期合理治疗、有限分离心包粘连、术后加强血流动力学监测、注意心功能支持及呼吸支持等措施,可进一步提高手术效果。Objective To analyze the clinical data and therapeutic efficacy for heart valve replacement （HVR） after closed mitral commissurotomy with rheumatic heart disease. Methods Thirty four patients with HVR after closed mitral commissurotomy from August 2001 to July 2002 in Changhai hospital were recruited. The average interval between the two operations was 4-29 （12.6±6.73）years. Two of them （5.9%） received mitral valve replacement （MVR）, 16 cases （47.1%） had MVR and tricuspid valvuloplasty （TVP De-vega）, 2 cases （5.9%） had double （aortic and mitral） valve replacement （DVR）, 14 cases （41.2%） had DVR and TVP. Cross-check analysis was done with 257 HVR patients at cotemporary. Results There was no obviously difference in the HVR after closed mitral commissurotomy patients compare with HVR at cotemporary in sex, age, heart function, modus operandi, the CPB, the time of aortic blockage, early postoperative mortality, etc. Conclusion Closed mitral commissurotomy corrected the function of pathological mitral valve, but the proceeding of disease was not changed. They must be operated as soon as possible if the patient＇s condition aggravation after closed mitral commissurotomy.

关 键 词：风湿性心脏病 心脏外科手术 心脏瓣膜 人工瓣膜 二尖瓣闭式扩张 

分 类 号：R654.2[医药卫生—外科学]