小左室心脏瓣膜置换术临床经验探讨  

Cardiac Valve Replacement of Small Left Ventricle

作　　者：高廷朝[1] 王平凡[1] 徐宏耀[1] 朱汝军[1] 李有金[1] 刘淼[1] 

机构地区：[1]河南省胸科医院心血管外科,郑州市450008

出　　处：《医药论坛杂志》2008年第20期1-2,共2页Journal of Medical Forum

摘　　要：目的总结小左室瓣膜置换术的经验。方法自2006年3月-2008年2月共行小左室心脏瓣膜置换术76例，其中男性32例，女性44例，年龄43～75岁，平均（52±3）岁。单纯二尖瓣狭窄41例，二尖瓣狭窄合并轻中度主动脉瓣狭窄7例，合并三尖瓣关闭不全28例，中度以上肺动脉高压52例，二尖瓣闭式扩张术后8例。心脏彩超左室舒末径（LVEDD）为（35±2．5）mm，左室舒末容积指数（LVEDV）为（56±3．8）ml／m^2，射血分数（EF）为（41±5）％。术前准备后在全麻低温体外循环下行二尖瓣置换术，4例同时行主动脉瓣置换术。应用冷氧合血性停跳液心肌保护。结果平均体外循环时间（60±7）min，平均主动脉阻断时间（35±5）min。术后发生低心排4例（5．2％），发生肾衰1例（1．3％）。结论①小左室心脏瓣膜病属重症心脏瓣膜病，术前应充分准备；（爹小左室心脏瓣膜置换术中注意心肌保护，防止心肌损伤，尽量保留二尖瓣后瓣瓣下结构，人工瓣型号不宜过大，大开口方向对向室间隔；③术后应用强心利尿扩血管药物时间延长，心率在90次／min左右为宜，防止快速心律失常的发生。Objective To sum up the experience of valve replacement in small left ventricle. Methods Total 46 patients with small left ventricle were carried out cardiac valve replacement from March 2006 to Feb. 2008. Male ： 32, female ：44. Total 41 patients were mitral valve stenosis （MS） alone. 7 patients with MS also had aortic valve stenosis（AS）. 28 patients with MS had tricuspid valve in- competence （TVI）. 8 patients had been carried out mitral valve dilatation before. The left ventricle end diastolic diameter （LVEDD） was （35±2.5 ） min. The left ventricle end diastolic volume was （ 56±3.8） ml/m^2. The efflux fraction was （41±5） %. Under general anesthesia and eardio pulmonary by- pass（CBP） ,mitral valve replacements were carried out. 4 patients also were carried out aortic valve replacement at the same time. The hypothemic oxygenation blood cardiac anesthesia fluid was used for myocardiac protection. Results The CPB mean time was （60±7 ） mins. Mean time of clamping aorta was（35±5）mins. 4 patients had the low cardiac output syndrome after operation （5.2%）. 1 patient had renal function failure after operation （ 1.3% ）. 1 patient died from multi - organic function failure （ 1.3% ）. Conclusion ①The cardiac valve disease of small left ventricle were serious valve disease. Full preparation should be used before operation. ②The following things should be paid attention in valve replacement operation： protecting myocardia and avoiding myocardia damage,reserving the structure under the rear valve,the big opening of mechanic valve should face the ventricle septal and the mechanic valve should be choiced as small as possible. ③The time of using cardiac tonic and vasodilator should be prolonged. The heart rate should be about 90 beats/min. Tachyarrhythmia should be avoided.

关 键 词：小左室 心脏疾病 瓣膜置换术 

分 类 号：R654.2[医药卫生—外科学]