自体肺动脉瓣移植术围术期治疗  

Peri-operative Treatment in Patients Undergoing Pulmonary Valve Autograft

作　　者：石秋霞[1,2] 贾世杰[1,2] 张健群[1,2] 李温斌[1,2] 陈英[1,2] 李小密[1,2] 

机构地区：[1]北京市心肺血管医疗研究所 [2]首都医科大学附属北京安贞医院心脏外科监护室,北京市100029

出　　处：《中国全科医学》2010年第14期1582-1584,共3页Chinese General Practice

基　　金：2003年度国家自然科学基金面上项目(30371412/C03030304)

摘　　要：目的总结自体肺动脉瓣移植术(Ross手术)围术期治疗的经验。方法我院1994年10月—2009年2月共收治了58例中重度主动脉瓣病变行Ross手术者,其中男42例,女16例;平均年龄(28±15)岁。术前诊断:先天性心脏病,主动脉瓣中重度狭窄和(或)关闭不全54例;亚急性细菌性心内膜炎(SBE)合并主动脉瓣关闭不全1例;主动脉瓣人工机械瓣置换术后心内膜炎合并瓣周漏1例;主动脉瓣成形术后主动脉瓣大量反流1例;老年性退行性重度主动脉瓣狭窄1例。患者术前均行超声心动图(UCG)检查。术前准备:NYHA心功能分级Ⅰ、Ⅱ级患者术前按心脏手术常规准备,心功能Ⅲ级患者术前给予洋地黄、利尿剂、极化液治疗,待心功能改善后再行手术。手术方式:患者均在全麻中度低温体外循环下接受Ross手术,手术顺利。围术期监护治疗措施:严密监测生命体征,积极补充血容量,维持水、电解质和酸碱平衡,预防并有效处理心律失常的发生,维护心功能,加强抗炎治疗。结果58例患者术后死亡1例(1.7%),自动出院1例;术后主动脉瓣平均跨瓣压差为(6.11±0.12)mmHg,显著低于术前的(35.56±9.10)mmHg;左室舒张末期内径(LVDD)为(56±3)mm,亦显著低于术前的(62±5)mm,差异均有统计学意义(P<0.01)。左室射血分数为(0.49±0.22)%,心功能均为Ⅰ～Ⅱ级。结论Ross手术是治疗主动脉瓣病变的有效方法,良好的围术期治疗为手术的成功提供了有力帮助。Objective To summarize the experience on peri-operative treatment in patients receiving pulmonary valve autograft （Ross Procedure）.Methods Fifty-eight patients with severe aortic valve lesions,admitted to our hospital from October 1994 to Februry 2009,42 males,16 females,averaging in age of 28±15,received Ross procedure.According to pre-operative diagnoses,congenital heart disease （CHD）,aortic valve disease （AS/or AI） were found in 54 patients,subacute bacterial endocarditis （SBE）,aortic incompetence in 1,SBE with peri-valve leakage after aortic mechanical valve replacement in 1,aortic incompetence after aortic valve plasty in 1,elderly degenerated aortic valve disease in 1.Ultrasonic cardiogram was performed.Pre-operative preperations were：conventional preperations for heart function NYHA Ⅰ,Ⅱ patients,digitalis,diuretic and polarized solution for NYHA Ⅲ patients,procedure performed after heart function improvement.Patients received procedure under general anesthesia and in moderate hypothermic cardiac-pulmonary bypass （CPB）.Vital sign was closely monitored,blood volume added positively,water,electrolyte and acid-base balance maintained,arrhythmias prevented and effectively dealt,heart function maintained and anti-inflammatory treatment enhanced.Results One patients died after procedure （1.7%）,1 auto-discharged.The average pressure difference of aortic valve was 6.11±0.12 mm Hg,significantly lower than before procedure （35.56±9.10 mm Hg）,and left ventricular diastolic diameter （LVDD） was 56±3 mm,lower than before procedure （62±5 mm）,the difference was significant （P0.01）.Left ventricular ejection fraction was （0.49±0.22）%,heart function were between grades Ⅰ～Ⅱ.Conclusion Ross procedure is an effective method in treatment of aortic valve lesions.Good peri-operative treatment provides a powerful help for a successful operation.

关 键 词：ROSS手术 手术期间 移植 自体 主动脉瓣关闭不全 主动脉瓣狭窄 

分 类 号：R542.52[医药卫生—心血管疾病]