人工心脏瓣膜置换手术的随访和中远期疗效分析  

Follow-up of the artificial heart valve replacement andanalyze the long-term curative effect

作　　者：马浩[1] 王奇[1] 石海燕[1] 王立新[1] 马振海 张晓[1] 

机构地区：[1]武警总医院心血管外科,北京100039 [2]河北省肃宁县中医院内科

出　　处：《中国综合临床》2012年第5期534-538,共5页Clinical Medicine of China

摘　　要：目的分析我院317例次人工心脏瓣膜置换手术的临床特点和随访结果，全面评价手术疗效。方法2005年7月至2010年6月我院共行人工心脏瓣膜置换手术317例，其中机械瓣置换284例，生物瓣置换33例。通过总结其年龄、病因、手术方式、瓣膜类型等临床特点，并经过术后随访，观察术后心功能的恢复、并发症的发生和病死率等情况。结果围术期死亡6例，存活311例。术后随访291例，随访率93．57％，随访时间1．00—4．75年，平均（2．23±1．37）年。随访平均心功能（2．05±0．29）级，较术前（3．17±0．62）级有明显改善（t=2．366，P〈0．05），且与术时年龄、术前心功能等有关（P均〈0．05）。随访期间死亡1例，术后中远期并发症的发生与人工瓣膜类型等因素相关（P均〈0．05）。结论人工心脏瓣膜置换术后疗效满意，心功能改善明显，存活率高。选择合理的手术时机、使用合适的人工瓣膜类型、加强术后门诊随诊可以减少术后并发症的发生。Objective To review the clinical features and the follow-up results of 317 cases of patients treated with artificial heart valve replacement and evaluate the curative effect. Methods Data of 317 patients underwent artificial heart valve replacement from July 2005 to June 2010 was analyzed, among them,284 patients replaced with mechanical valve and 33 patients with biological valve. Clinical features including age, etiology, surgical approach, valve type, etc, were summarized and the recovery of cardiac function, the incidence of complication and mortality were observed through postoperative follow-up. Results There were 6＇ patients died in the perioperative period and 311 survived. Two hundred and ninety-one cases were followed up and the follow-up rate was 93.57%. The time of follow-up is 1.00 to 4.75 years（ with average：2. 23 ±1.37 years）. The cardiac function（NYHA） was significantly improved after operation（ grade： 2.05±0. 29 vs 3.17± 0. 62 ） （t = 2. 366, P 〈 0.05）. It was related to age, cardiac function before operation （ P 〈 0. 05 ）. One patient died during the follow-up period. The statistics analysis showed that the long-term incidence Of complication was related to the type of heart valve prosthesis （ P 〈 0. 05 ） . Conclusion The therapeutic effect of artificial heart valve replacement surgery appears satisfactory. Heart function is improved significantly and the survival rate is high. Reasonable timing of surgery, appropriate type of prosthetic valve and intensified clinical follow-up can help to reduce the occurrence of postoperative complication.

关 键 词：心脏瓣膜病 瓣膜置换手术 瓣膜假体 

分 类 号：R654.2[医药卫生—外科学]