连续259例心脏瓣膜替换无围手术期死亡的临床分析  

Non-death analysis of 259 consecutive cases with prosthetic valve replacements

作　　者：高百顺[1] 宋兵[1] 尤涛[1] 柳德斌[1] 唐汉博[1] 张彬[1] 

机构地区：[1]兰州大学第一医院心脏外科,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2006年第3期66-68,共3页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的 总结连续259例瓣膜替换手术无死亡经验，以期提高手术疗效，避免手术并发症，降低手术死亡率。方法 2000年1月-2005年8月，连续施行259例瓣膜替换术。男137例，女122例。年龄10～71（41．69±10．57）岁。风湿性心脏瓣膜病235例，退行性16例，马凡综合征7例，三尖瓣下移畸形1例。术前心功能Ⅱ级46例，Ⅲ级141例，Ⅳ级72例。心胸比率0．64～0．91（0．73±0．09）。单纯二尖瓣替换133例，主动脉瓣替换59例，二尖瓣和主动脉瓣联合替换63例，其他4例。结果 本组259例病入围手术期无1例死亡，无严重并发症发生。结论 瓣膜病患者大部分术前心功能较差，围手术期有一定死亡率。如果术前严格准备，术中做好心肌保护，并做到手术操作精细、准确，术后维护血流动力学稳定，及时防治并发症，可明显降低围手术期死亡率。Objective To summarize clinical results of 259 consecutive cases with prosthetic valve replacements, improve curative effect, avoid operative complications and reduce operative mortality. Methods 259 consecutive cases of prosthetic valve replacements from Jan 2000 to Aug 2005 were included, male in 137, female in 122, aged from 10-71 years old, with a mean of 41. 69± 10. 57 years old. Rheumatic disease was presented in 235, degenerative in 16, Mafan＇s syndrome in 7 and Ebstein＇s malformation in 1. The grade of cardic function of the patients was in NYHA 11 （46）, Ⅲ （141） and Ⅳ （72）. 133 patients underwent mitral valve replacement （MVR）, 59 aortic valve replacement （AVR）, 63 combined MVR and AVR and 4 other type. Results All patients underwent prosthetic valve replacements were alive in perioperation, even without severe complications. Conclusion Patients with valve heart disease generally had poor cardic function, most of them died from postoperative severe complications. However, the operative mortality will be significantly reduced if we pay attention to several points, which include good preoperative preparation, skilled technique, stabilized hemodynamics in perioperation and avoiding severe complications in earlier postoperation.

关 键 词：心脏瓣膜疾病 心脏瓣膜替换术 无围手术期死亡 

分 类 号：R654.2[医药卫生—外科学]