大左室心脏瓣膜病49例围术期治疗体会  

The perioperative treatment experience of cardiac valve disease with giant left ventricle for 49 cases

作　　者：刘涛[1] 林称意[1] 罗卫民[1] 刘华[1] 张群献[1] 郭家龙[1] 

机构地区：[1]湖北省十堰市太和医院(湖北医药学院附属医院)胸心大血管外科,442000

出　　处：《临床外科杂志》2017年第5期369-371,共3页Journal of Clinical Surgery

摘　　要：目的总结大左室心脏瓣膜病患者围术期处理经验。方法大左室心脏瓣膜病患者49例,术前均行心脏超声检查明确心脏病变情况;按NYHA心功能分级标准对患者心功能进行分级。患者均在全麻低温体外循环下行手术治疗,手术方式主要有主动脉瓣置换术、二尖瓣置换术、主动脉瓣+二尖瓣置换术。部分患者同期行三尖瓣成形术、左房折叠术。结果术后早期死亡2例(4.08%),原因分别为低心排出量综合征(1例),室性心律失常(1例)。术后早期并发症主要有室性心律失常,低心排出量综合征,胸腔积液,心包积液,肺部感染,肾功能不全,出血。其余47例患者痊愈出院。结论大左室心脏瓣膜病患者病情重,手术风险大,术后并发症发生率及死亡率高。积极行术前准备,改进手术技术,注重心肌保护,术后加强管理,可改善手术效果。Objective To summarize the experience of perioperative management of patients with giant left ventricle for valvular disease.Methods Retrospective analysis the clinical data about the patients who underwent cardiac valve operation with giant left ventricle.Echocardiography was performed before surgery to determine the condition of the heart（such as left ventricular diastolic,left ventricular ejection fraction and so on）.According to the NYHA cardiac function classification criteria,the patients were divided into 3 grade.All patients were operated under general anesthesia and hypothermia cardiopulmonary bypass.Surgical methods were as follows：aortic valve replacement,mitral valve replacement,two methods combine with each other.Some patients also underwent tricuspid valvuloplasty and left atrial folding operation at the same time.Results Early postoperative death occurred in 2 patients（4.08%）.The reasons were as follows：1 case was low cardiac output syndrome,another was ventricular arrhythmia.Early postoperative complications were mainly ventricular arrhythmia,low cardiac output syndrome,pleural effusion,pericardial effusion,pulmonary infection,renal insufficiency,hemorrhage.The remaining 47 patients were cured.Conclusion Cardiac valve disease with giant left ventricle has high risks when underwent operation.At the same time,postoperative complication rate and mortality were high.The key to improve the surgical results of such patients is to make adequate preoperative preparation,improve surgical technique,focus on myocardial protection and strengthen the postoperative management.

关 键 词：大左室 心脏瓣膜病 术后并发症 

分 类 号：R654.2[医药卫生—外科学]