机械瓣膜置换术后瓣膜故障再次手术换瓣临床分析  

Clinical analysis of reoperation due to valve dysfunction after mechanical valve replacement

作　　者：黄国晖[1] 张健群[1] 孙广龙[1] 迟立群[1] 穆军升[1] 

机构地区：[1]首都医科大学附属北京安贞医院心外科十病房,100029

出　　处：《中国医药》2012年第9期1066-1068,共3页China Medicine

摘　　要：目的观察机械瓣膜置换术后瓣膜故障再次手术换瓣临床效果，分析故障原因、手术时机选择及手术效果。方法选择2003年3月至2010年5月行再次手术换瓣患者33例，其中二尖瓣置换术17例、主动脉瓣置换术9例、二尖瓣＋主动脉瓣置换术2例、二尖瓣置换＋三尖瓣成形术2例、三尖瓣置换术3例。治疗前后对患者行心功能评级，参照纽约心脏病协会（NYHA）心功能标准，进行比较分析。结果33例再次手术换瓣患者中，死亡1例（3．0％），32例存活患者心功能明显改善。33例患者术前心功能分级Ⅰ级0例，Ⅱ级13例（39．4％），Ⅲ级15例（45．4％），Ⅳ级5例（15．2％）；术后6个月复查，32例患者存活，心功能分级I级16例（50．0％），Ⅱ级12例（37．5％），Ⅲ级4例（12．5％），Ⅳ级0例。术后6个月与术前心脏功能相比，Ⅰ、Ⅲ、Ⅳ级患者比例差异均有统计学意义（均P〈0．05）。Ⅱ级手术前后差异无统计学意义（P〉0．05）。结论人工机械瓣膜置换术后瓣膜故障，再次手术置换新瓣是其主要治疗手段，要注意手术时机、手术方法和瓣膜种类的选择。Objective To observe the effect of the re-operation after mechanical valve replacement and to analyze dysfunction reason, operation time and operation effect of reoperation. Methods Thirty-three cases with reoperation of valve replacement were chosen from March 2003 to May 2010, including 17 cases of mitral valve replacement, 9 aortic valve replacement, 2 mitral valve and aortic valve replacement, 2 mitral valve replacement and 3 tricuspid valve annuloplasty and 3 tricuspid valve replacement. Heart function was compared before and after operation according to the New York Heart Association （NYHA）. Results Among 33 cases of reoperation, Ⅰ case （3.0%） died and heart function of 32 survival cases improved significantly. The number of preoperative heart function grade Ⅰ , Ⅱ, Ⅲ, Ⅳ was 0, 13 （39.4%）, 15 （45.4%） and 5 （ 15.2% ）. After 6 months, 32 patients survived; the number of preoperative heart function grade Ⅰ , Ⅱ, Ⅲ, IV was 16 （50.0%）, 12 （37.5%）, 4 （ 12. 5% ） and 0. The proportion of the patients in grade Ⅰ , Ⅲ, Ⅳ showed statistical difference （ P 〈 0.05 ）. Conclusion Reoperation is the main therapy method of treating valve dysfunction after mechanical valve replacement ; we should pay attention to operation time, operation method and selection of valve type.

关 键 词：人工机械瓣膜置换术 机械瓣膜功能障碍 再次手术 

分 类 号：R654.2[医药卫生—外科学]