危重心脏瓣膜置换早期死亡原因及对策  

The study on the causes of Early death and the pireoperative management of cardiac valve replacement in patients with severe diseases

作　　者：李鲁[1] 马黎明[2] 褚衍林[1] 林毅[1] 程前进[2] 王志鸿[1] 李祥[2] 

机构地区：[1]解放军306医院心胸外科,北京100101 [2]济宁医学院附属医院心脏外科

出　　处：《北京医学》2012年第7期542-545,共4页Beijing Medical Journal

摘　　要：目的探讨危重心脏瓣膜病手术早期死亡因素及对策。方法总结420例危重心脏瓣膜病施行瓣膜置换的患者的临床资料,男202例,女218例,年龄(40.0±8.7)岁。术前心功能Ⅲ级92例,Ⅳ级328例。二尖瓣置换237例,主动脉瓣置换20例;二尖瓣+主动脉瓣置换142例;二尖瓣置换+主动脉置换+三尖瓣置换15例;三尖瓣置换6例。采用机械瓣569枚,生物瓣23枚。同时施行三尖瓣成形术242例,左房血栓清除术62例,左房成形术42例,冠状动脉搭桥术52例,动脉导管未闭腔内缝合术14例,室间隔缺损修补术6例,主动脉窦瘤破裂修补术12例,无顶冠状窦修补及异常传导束切割术各2例。结果早期死亡13例(3.09%)。低心排出量综合征、呼吸衰竭、心室颤动及多脏器功能衰竭为常见原因。结论注重术前准备,适当选择手术时机,合理纠正病变,避免手术不当并发症及加强术后并发症处理可进一步提高外科疗效。Objective To study the causes of early death and peri-operative management of cardiac valve replacement in patients with severe diseases. Methods Valve replacements were performed in 420 cases with severe cardiac valve diseases from April 1996 to July 2009. There were 202 male and 218 female, with an age ranged from 12 to 78 years. Preoperative heart function （NYHA） in 92 cases were chass III and 328 cases were in class IV. Mitral valve replacement were performed in 237 cases, Aortic replacement in 20, both mitral and aortic in 142, three valves with mitral, aortic and tricuspid in 15, and tricuspid in 6. 569 mechanical valves and 23 bioprostheses were implanted. Associated procedures were tricuspid annuloplasty in 242 cases, left atrium thrombectomy in 62, annuloplasty in 42, coronary artery bypass grafting in 52 cases, closing of patent ductus arteriosus transpulmonary artery in 14,repair of ventricular septal defect in 6, and repair of aneurysm of the sinus of valsalva in 12, and repair of unroofed coronary sinus and surgical interruption of the Bundle of Kent in patient with W-P-W syndrome in 2 respectively. Results Thirteen（3.09%） patients were defined as early deaths. Low cardiac output, ventricular fibrillation, respiratory failure and multiple organ failure were the most frequent causes of mortality. Conclusion According to characteristics of severe patients, paying attention to preoperativepreparation, selecting the most appropriate operative chance and correcting pathological changes, avoiding operative complications, and strengthening management of postoperative complication may have an excellent results in severe patients.

关 键 词：瓣膜置换 风湿性心脏病 危重心脏瓣膜病 

分 类 号：R654.2[医药卫生—外科学]