生物瓣失功能病人的再次换瓣经验  

Experience of heart valve re-replacement in patients with bio-prosthesis dysfunction

作　　者：郑家豪[1] 朱洪生[1] 黄日太[1] 梁保罗[1] 富皓白[1] 梁而慷[1] 殷荣[1] 

机构地区：[1]上海第二医科大学附属仁济医院心胸外科,200001

出　　处：《上海医学》2002年第1期11-13,共3页Shanghai Medical Journal

摘　　要：目的　总结 43例生物瓣失功能病人的再次换瓣及围术期处理经验。方法　自 1988年 7月至1999年 12月共 43例生物瓣失功能病人行再次手术换瓣。两次换瓣间隔时间为 4～ 18(平均 9.3± 3.0 )年。术前心功能Ⅱ级 3例 ,Ⅲ级 2 3例 ,Ⅳ级 17例。再次手术行二尖瓣置换 (MVR) 2 7例 ,MVR +三尖瓣成形 (TVP) 9例 ,主动脉瓣置换 (AVR) 2例 ,二尖瓣主动脉瓣双瓣置换 (DVR) 5例。结果　早期手术 (1988年 7月至 1991年12月 )死亡 5例 ,死亡率 31.3% (5 / 16 ) ;后期 (1992年后 )死亡 1例 ,死亡率 3.7% (1/ 2 7) ;在术前心功能均≥Ⅲ级。术后并发症 2 4例。结论　对生物瓣失功能病人需尽早行手术治疗。术前改善心功能、术中勿过多分离粘连及加强心肌保护、防止术后低心排的发生是降低手术死亡率的关键。Objective To summarize the experience of heart valve re replacement and perioperative treatment of patients with bio prosthesis dysfunction (BPD). Methods 43 heart valve re replacements were performed for patients with BPD from Jul. 1988 to Dec. 1999. The interval between two procedures was 4 to 18 years(average 9.3±3.0 years). Their cardiac function (CF) before reoperation were class Ⅱ(3 cases), classⅢ(23 cases) and classⅣ(17b cases). Selective re operation consisted of mitral valve replacement (MVR) in 27 cases, MVR plus tricuspid valvoplasty(TVP) in 9, aortic valve replacement (AVR) in 2 and double valve replacement (DVR) in 5.Results fThere were 6 early deaths, all of whom had CF in class Ⅲ. In early years from Jul. 1988 to DEC. 1991, the mortality rate was 31.3%, which decreased to 3.5% after 1992. Twenty four complications occurred after operation. Conclusion Reoperationi should be prompt and heart function be improved before operation. During the procedure, cardiac protection was stressed and excessive dissection of pericardial adhesions should be avoided.

关 键 词：生物瓣失功能 再次换瓣 围手术期 处理经验 

分 类 号：R654.2[医药卫生—外科学]