巨大心脏瓣膜替换术围手术期处理  

EXPERIENCE IN THE PERIOPERATION MANAGEMENT FOR VALVULAR LESION WITH GIANT HEART

作　　者：沈家宜[1] 严志焜[1] 孔颂阳[1] 朱理[1] 许林海[1] 程颖[1] 

机构地区：[1]浙江省人民医院胸心外科

出　　处：《上海医学》1996年第11期631-633,共3页Shanghai Medical Journal

摘　　要：为提高巨大心脏（ＣＴＲ＞０．７０）瓣膜替换术的手术疗效，作者回顾性分析了３３例病人的围手术期治疗经验及随访结果。３３例病人中，心功能Ⅲ级２２例，Ⅳ级１１例。其中属心源性恶液质７例，巨大左室（ＥＤＤ＞７０ｍｍ）１１例。手术方式：二尖瓣替换术（ＭＶＲ）１７例，主动脉瓣替换术（ＡＶＲ）３例，ＡＶＲ＋ＭＶＲ１３例，并行三尖瓣成形术１１例。术后早期死亡２例（６．１％），长期生存的３１例中，心功能Ⅰ级１３例，Ⅱ级１７例，Ⅲ１例，晚期死亡１例（车祸）。我们体会术前积极改善心脏功能，术中加强心肌保护并注意保留二尖瓣后瓣健索，术后加强对心、肺、肝等重要脏器功能的保护，是提高手术疗效的重要措施。n order to improve the valvular replacement operative results in the patients with giantheart(CTR>0.70),a retrospective analysis of perioperation management experience in 33patients is reported. Among them heart function class NYHA was Ⅲ in 22 and Ⅳ in 11.7patients were associated with cardiac cachexia,and 11 patients with giant left ventricle(EDD>70mm).Operative procedures consisted of MVR in 17 cases,AVR in 3,MVR+AVRin 13,and 11 patients were performed on TVP simultaneously.Early postoperative death oc-cured in two cases(6.06%). There was one late death(traffic accident). We believe that vig-orously improving preoperative heart function, enhancing myocardial protection,retainingsecondary and tertiary chordae of mitral posterior leaflet as much as possible,and postopera-tively protecting the heart,lung and liver function are important measurements to improvethe operative results.

关 键 词：心脏瓣膜病 瓣膜替换术 围手术期 

分 类 号：R542.505[医药卫生—心血管疾病] R654.205[医药卫生—内科学]