46例小儿风湿性心脏病瓣膜置换术及长期随访分析  

The results of the follow up study of cardiac valves replacements in pediatric patients with rheumatic heart diseases

作　　者：李江林[1] 李渝芬[1] 陈寄梅[1] 张镜芳[1] 罗征祥[1] 庄建[1] 

机构地区：[1]广东省心血管病研究所,广东广州510100

出　　处：《临床儿科杂志》2005年第12期851-853,共3页Journal of Clinical Pediatrics

摘　　要：目的分析 46例小儿风湿性心脏病瓣膜置换术临床及长期随访资料,探讨小儿瓣膜置换术的临床价值.方法收集 1976～ 2005年 15岁以下接受瓣膜置换术的小儿风湿性心脏病病例共 46例,其中行二尖瓣置换术( MVR) 40例,主动脉瓣置换术( AVR) 2例,二尖瓣加主动脉瓣双瓣置换术 4例,同期行三尖瓣整形术( TVP) 19例.置换生物瓣( GD-Ⅰ型) 11例,机械瓣 35例. 结果术后心功能Ⅰ～Ⅱ级,较术前改善,差异有显著性( P<0.05).左室舒张末径( LVDD)由术前的( 60.7± 7.3) mm缩小至( 49.3± 8.9) mm,差异有显著性( P<0.05).住院死亡 3例,死因包括严重心律失常、低心排、多器官系统功能衰竭;治愈出院 43例,随访( 6.1± 5.8)年( 1个月～ 29年),出现人工瓣失功能 12例,其中 8例于术后 2～ 5年死亡,另 4例分别于术后 3年、 4年、 5年和 8年行 2次 MVR术,治愈 3例,死亡 1例. 结论小儿风湿性心脏瓣膜病的外科治疗首选瓣膜置换术,并应选择机械瓣;术后长期口服抗凝药物是有效和安全的.Objective To retrospectively analyze the data of 46 patients with rheumatic heart diseases and to explore the clinical importance of cardiac valves replacements. Methods 46 patients younger than 15 years received cardiac valves replacements from 1976 to 2005 were involved. Mitrial valve replacements （MVR） were performed in 40 cases, aortic valve replacements （AVR） were performed in 2 cases, and MVR plus AVR were performed in 4 cases. 19 cases received additional tricuspid valvuloplasty at the corre- sponding time. The substitutional valves included 11 biotic ones and 35 mechanic ones. Results Heart function significantly improved after surgery （level Ⅰ to level Ⅱ ） （P〈0.05）. End diastolic diameter of left ventricles also dramatically decreased （60.7±7.3 mm before the operation, 49.3±8.9 mm after the operation, P〈0.05）. 3 patients died of severe arrhythmia, low cardiac output, and multiple system failure during hospital time. 43 patients have been followed up for 1 month to 29 years. Among them, 12 suffered from dysfunction of artificial valves, 8 of them died, and the other 4 patients underwent re-surgery of MVR. 3 cured and 1 died. Conclusions Cardiac valves replacements should be the best option for pediatric patients with rheumatic heart diseases. And mechanical valves should be chosen. Long-term anticoagulative therapy after the surgery is effective and safe.

关 键 词：瓣膜置换术 风湿性心脏病 小儿 

分 类 号：R726.5[医药卫生—儿科]