再次人工瓣膜置换69例临床分析  

Reoperation after artificial valve prosthesis replacement： an analysis of 69 cases

作　　者：修宗谊[1] 谷天祥[1] 章志伟[1] 张光伟[1] 喻磊[1] 姜大庆[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,辽宁省沈阳市110001

出　　处：《中国心血管病研究》2015年第7期607-609,共3页Chinese Journal of Cardiovascular Research

基　　金：辽宁省自然科学基金（项目编号：201102292）

摘　　要：目的探讨再次人工心脏瓣膜置换手术的最佳方法及安全性。方法2006年5月至2014年5月中国医科大学附属第一医院心脏外科住院再次心脏瓣膜手术患者69例，置换二尖瓣瓣膜31个，修复17个；置换主动脉瓣15个，修复10个；三尖瓣置换3个。术前心功能分级（NYHA）Ⅱ级22例、Ⅲ级31例、Ⅳ级16例。结果住院期间死亡5例，死亡率7．25％（5／69）。术后随访49例（随访率76．56％），随访时间7个月至8年。随访中再手术6例，死亡7例。存活42例，心功能Ⅲ级1例、Ⅱ级12例，余心功能正常。结论对瓣膜置换术后任何原因导致的重度瓣膜功能障碍，早期诊断、及时采取正确的手术方法将有利于提高患者的生存率。外科手术联合药物治疗是提高术后生存质量的关键。Objective To evaluate the safety and accuracy of the reoperation after artificial valve prosthe- sis replacement, explore the operation method and technical note. Methods From May 2006 to May 2014, we performed reoperation on 69 patients. Among the patients, there were 31 cases of mitral valvular replacement, 17 cases of mitral valvular repairing, 15 cases of aortic valvular replacement, 10 eases of aortic valvular repairing, 3 eases of tricuspid valvular replacement. Before reoperation, the cardiac function （NYHA） of the patients was class Ⅱ in 22 patients, class Ⅲ in 31 patients, and class Ⅳ in 16 patients. Results There were 5 hospital deaths with a mortality of 7.24%（5/69）. Follow-up was done to 49 eases for 7 to 96 months, which showed 6 case reop- erations and 7 eases late deaths. All other 42 cases recovered to NYHA class Ⅰ to Ⅱ. Conclusion The early diagnosis and timely reoperation of severe vavular dysfunction caused for any reason after artificial valve prosthesis replacement may improve the survival rate. And the key to higher life quality is the combination of surgical opera- tion and pharmacotherapy.

关 键 词：人工瓣膜置换 再次手术 临床分析 

分 类 号：R654.2[医药卫生—外科学]