重症瓣膜病的外科治疗  

Surgical Treatment of Severe Valvular Heart Disease

作　　者：俞晓立[1] 张冬成[1] 林清文[1] 于涛[1] 秦显雨[1] 

机构地区：[1]广州医学院第二附属医院,广东广州510260

出　　处：《中外医学研究》2013年第19期18-20,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的：总结重症心脏瓣膜病外科治疗的经验，探讨提高手术成功率的措施。方法：回顾性分析1998年8月-2012年12月笔者所在医院收治的106例重症心脏瓣膜病患者的临床资料。其中男41例，女65例，年龄29～73岁，平均（41．2±15．6）岁。心功能Ⅲ级64例，Ⅳ级42例。二尖瓣替换35例，二尖瓣成形手术1例，主动脉瓣替换15例，双瓣替换55例，同期行三尖瓣成形41例和冠脉搭桥18例。结果：手术后早期死亡6例，死亡率为5．7％（6／106）。死亡原因：低心排综合征2例，心室纤颤1例，多脏器功能衰竭2例，脑梗死1例。100例出院患者中，随访89例，随访时间1个月～12年，死亡6例，死亡率6．7％（6／89），心功能I级48例，Ⅱ级36例，Ⅲ级5例。结论：重症心脏瓣膜病的外科治疗应强调矫治二尖瓣和主动脉瓣病变，尽可能保留二尖瓣瓣下结构，积极治疗三尖瓣病变，选择合适的人工瓣膜。同时，还应加强围手术期处理，选择好手术时机，术前注重改善心功能，加强营养支持，这样就能改善重症心脏瓣膜病的治疗效果、降低手术死亡率。Objective： To summarize the experiences of surgical treatment of severe valvular heart disease and discuss the methods of how to improve the operative success.Methods： 106 patients with severe valvular heart disease received surgical treatment from October 1998 to January 2013.There were 41 males and 65 females, aged from 29 to 73 years, the average age was （41.2 ＋ 15.6）years.Heart function（New York Heart Association Functional Classification） were class m in 64 cases and class 1V in 42 cases pre-operation.Mitral valve replacement was performed in 35 cases.Mitral valve repair in 1 case.Aortic valve replacement in 15 cases.Double valves replacement in 55 cases.Concomitantly, tricuspid valve repaire and coronary artery bypass grafting were applied in 41 and 18 cases respectively.Results： 6 cases died early after operation（mortality rate 5.7%）.Death causes include 2 cases of low cardiac output syndrome, 1 case of ventricular arrhythmia, 2 cases of multiple system organ failure and 1 case of cerebral infarct. 89 cases among 100 cases were followed up ranged from 1 month to 12 years, and among them, 6 cases died（fatality rate 6.7%）, 48 cases were restored to heart function class I , 36 cases to class II, and 5 cases to class $ .Conclusion： Surgical treatment of severe valvular heart disease should focus on correcting pathological changes of mitral valve and aortic valve, reserving the mitral subvalvular structure as much as possible, treating disordered tricuspid valve and selecting appropriate artificial valves.Meanwhile, we should focus on selecting appropriately operative timing, improving pre-surgical heart function and enhancing nutrition.These measures can be expected to improve the surgical outcomes of severe valvular heart disease and lower operative mortality.

关 键 词：心脏瓣膜病 外科治疗 二尖瓣替换 主动脉瓣替换 三尖瓣成形 

分 类 号：R654.2[医药卫生—外科学]