重症心脏瓣膜病的围术期管理  

Perioperative management of severe valvular disease

作　　者：刘虎[1] 张义和[1] 单飞[1] 任建立[1] 马星星[1] 蔡振杰[1] 

机构地区：[1]延安大学附属医院心脏血管医学中心,陕西省延安市716000

出　　处：《中国心血管病研究》2017年第2期162-164,共3页Chinese Journal of Cardiovascular 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2012年3月至2016年2月延安大学附属医院治疗的58例重症心脏瓣膜病患者的临床资料，其中男性41例、女性17例，年龄36-72（52．6±17．2）岁。术前以改善心功能为主，选择恰当手术时机。术中注意保护心肌，尽量保留二尖瓣瓣下组织，积极处理巨大左房及三尖瓣返流。术后强心、扩管、利尿以减轻心脏负荷，同时防治心律失常，并进行合理的心脏康复治疗。结果手术后早期死亡2例，死亡率为3．4％（2／58），死因均为低心排综合征。随访56例，随访时间为1个月至4年，死亡1例。结论对于重症心脏瓣膜病患者，重视围手术期的每个环节的管理，可提高手术成功率。Objective To summarize the experience of the surgical treatment of severe valvular disease, and to improve the success rate of operation measures. Methods The clinical data of 58 patients with severe valvular disease admitted in our hospital from March 2012 to February 2016 were retrospective analyzed. There were 41 males and 17 females, aged 36-72（52.6±17.2）years. The heart function was improved and chosed the ap- propriate timing of surgery preoperative. During intraoperation, more attentions were paying to myocardial protection, preserving the mitral subvalvular apparatus, and actively dealling with giant left atrium and tricuspid valve regurgitation. After operation, the heart function was improved by dilating vessels and dieresis, and the cardiac ar- rhythmias was prevented and treated, and at the same time reasonable cardiac rehabilitation was administrated. Results Early postoperative death in 2 cases, the mortality rate was 3.4%（2/58）, the causes of death were low cardiac output syndrome. 56 cases were followed up ranged from 1 months to 4 years, 1 cases died. Conclusion In severe valve disease, pay attention to perioperative management of each link, can improve the success rate of surgery.

关 键 词：重症心脏瓣膜病 瓣膜置换 心脏康复治疗 

分 类 号：R654.2[医药卫生—外科学]