重症心脏瓣膜病的围手术期治疗经验  

The experiences of perioperative 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心外科,广东广州510260

出　　处：《赣南医学院学报》2013年第3期340-343,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:总结重症心脏瓣膜病外科手术的围手术期治疗经验,以降低手术风险,提高手术成功率。方法:分析106例重症心脏瓣膜病患者的临床资料。其中男性41例,女性65例,年龄29～73岁,平均(41.2±15.6)岁。心功能Ⅲ级64例,心功能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,手术死亡率为5.7%(6/106)。死亡原因为:低心排综合征2例,心室纤颤1例,多脏器功能衰竭2例,脑梗塞1例。100例出院患者中,随访89例,随访时间1月～12年,死亡6例,死亡率6.7%(6/89),心功能Ⅰ级患者48例,心功能Ⅱ级患者36例,心功能Ⅲ级患者5例。结论:重视重症心脏瓣膜病外科手术患者的围手术期治疗,选择恰当的手术时机,术前注重改善心功能,积极矫治心脏瓣膜病变,加强呼吸道管理,加强营养支持,积极防治心律失常,积极治疗围术期出现的肝、肾功能不全,可减少术后并发症、降低死亡率、提高外科手术疗效。Objective：To summarize the experiences of perioperative treatment of severe valvular heart disease.Discuss the methods of how to reduce surgical risks and improvethe overall surgical outcomes.Methods： 106 patients with severe valvular heart disease underwent surgical treatment from October 1998 to January 2013.There were 41 male and 65 female,aged 29 to 73years,the average age is（41.2 ± 15.6）.Heart function（New York Heart Association Functional Classification） was class Ⅲ in 64 cases and class IV 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 41and 18 respectively.Results： 6 cases died early after operation（fatality 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 follow up ranged from 1 month 12 years,and among them,6 cases died（fatality rate 6.7%）,48 cases were restored to heart function class Ⅰ,36 to class Ⅱ,and 5 to class Ⅲ.Conclusion： Perioperative management of severe valvular heart disease should focus on selecting appropriately operative timing,improvement of pre-surgical heart function,correcting pathological changes of heart valve,better management of airway and enhanced nutritional support,in-time treatment for arrhythmia,liver and kidney dysfunction during perioperative period.These measures can be expected to improve the surgical outcomes of severe valvular heart disease and lower operative morbidity and mortality rate.

关 键 词：心脏瓣膜病 围手术期治疗 二尖瓣替换 主动脉瓣置换术 三尖瓣修复 

分 类 号：R654.2[医药卫生—外科学]