手术治疗重度主动脉瓣狭窄101例临床分析  

Clinical analysis of 101 cases with severe aortic stenosis underwent aurgical treatment

作　　者：王常田[1] 魏磊[1] 张雷[1] 席志龙 孙磊[1] 吴海卫[1] 许飚[1] 李德闽[1] 

机构地区：[1]南京军区南京总医院心胸外科,江苏210002

出　　处：《江苏医药》2018年第1期43-46,共4页Jiangsu Medical Journal

摘　　要：目的总结101例重度主动脉瓣狭窄(AS)患者的临床表现和外科治疗经验。方法回顾性分析101例重度AS患者的临床资料。结果 101例中,9例(8.9%)无明显临床症状,有晕厥史18例(17.8%),胸痛史22例(21.8%),胸闷、呼吸困难史47例(46.5%),其他症状5例(5.0%)。主动脉瓣风湿性病变54例(53.5%),退行性病变34例(33.7%),感染性心内膜炎2例(2.0%),先天性病变11例(10.9%)(其中二叶瓣畸形9例,四叶瓣畸形2例)。单纯主动脉瓣置换80例,升主动脉带瓣管道置换术(Bentall术)8例,主动脉瓣置换+主动脉瓣环扩大术6例,主动脉瓣置换+冠状动脉旁路移植术6例,主动脉瓣置换+心房颤动射频消融(MazeⅣ)1例。共植入机械瓣92枚,生物瓣9枚。术后肺部感染5例(5.0%),心功能不全行主动脉内球囊反搏支持2例(2.0%),急性肾功能不全行连续性血液净化治疗3例(3.0%),发生完全性房室传导阻滞植入永久性起搏器5例(5.0%),二次开胸探查止血2例(2.0%)。术后30d内院内死亡3例(3.0%)。术后随访3个月~10年,随访率80.2%,3例死亡,其余患者纽约心脏病协会心功能分级为Ⅰ或Ⅱ级,生活质量明显改善。结论主动脉瓣置换是治疗重度AS的主要方法,可以有效改善患者生活质量,延长寿命。Objectives To summarize the clinical manifestation and surgical experience of 101 patients with severe aortic stenosis.Methods The clinical data of 101 patients with severe aortic stenosis were retrospectively analyzed.Results Of 101 cases,9 cases（8.9%）had no obvious clinical symptoms and the others were with the history of obvious clinical symptoms,which included syncope in 18 cases（17.8%）,chest pain in 22 cases（21.8%）,chest tightness and dyspnea in 47 cases（46.5%）and other symptoms in 5 cases（5.0%）.The pathological diagnosis of aortic valve included rheumatic disease（54 cases,53.5%）,degenerative disease（34 cases,33.7%）,infective endocarditis（2 cases,2.0%）,and congenital disease[11 cases（10.9%）,including bicuspid in 9 cases and quadricuspid in2 cases].All patients were subjected to aortic valve replacement,the associated procedures were Bentall procedure（8 cases）,aortic root enlargement（6 cases）,coronary artery bypass grafting（6 cases）,radiofrequency ablation of atrial fibrillation（MazeⅣ）（1 case）.Mechanical prostheses were implanted in 92 patients and bioprostheses were implanted in 9 patients.The complications included pulmonary infection（5.0%）,the support of intra-aortic balloon counterpulsation after heart failure（2.0%）,continuous renal replacement therapy after acute renal failure（3.0%）,pacemaker implantation（5.0%）,and exploratory thoracotomy for postoperative bleeding（2.0%）.The hospital mortality within 30 days was 3.0%.The follow-up rate was 80.2%.During the period of 3 months to10 years follow-up,3 patients died and the remaining patients recovered with cardiac function of NYHA classⅠtoⅡand significant improvement of life quality.Conclusion Aortic valve replacement is clearly indicated in the patients with severe aortic stenosis,which is able to effectively improve life quality and prolong life.

关 键 词：主动脉瓣狭窄 主动脉瓣置换术 

分 类 号：R654[医药卫生—外科学]