心脏瓣膜手术并发严重机械性溶血性贫血28例临床分析  

Severe mechanical hemolytic anemia after valve repair in 28 cases

作　　者：邹以席[1] 陈密 黄方炯[1] ZOU Yixi;CHEN Mi;HUANG Fangjiong(Department of Cardiac Surgery,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中华实用诊断与治疗杂志》2018年第9期880-882,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的探讨心脏瓣膜手术并发严重机械性溶血性贫血(mechanical hemolytic anemia,MHA)患者再次行手术治疗的效果。方法心脏瓣膜术后发生严重MHA患者28例,依据治疗方法分为保守治疗组12例和手术治疗组16例,保守治疗组给予减轻心脏后负荷、碱化尿液、补充铁剂、输血纠正贫血等对症治疗,手术治疗组在保守治疗基础上行瓣膜置换术,比较2组治疗效果。结果保守治疗组2例有手术禁忌证者因急性肾功能衰竭死亡,7例未及时诊断及治疗死亡;手术治疗组3例因二尖瓣瓣膜置换术后出现急性肾功能衰竭、上消化道出血死亡;对存活患者随访1个月~11a,保守治疗组1例术后2a复查超声心动图示二尖瓣反流为重度、余2例患者无异常,末次随访时心功能Ⅰ级2例,Ⅱ级1例;手术治疗组1例出院时有轻度肾功能不全,随访3个月时肾功能完全恢复正常,末次随访时均存活,心功能Ⅰ级8例,Ⅱ级5例。结论心脏瓣膜术后发生严重MHA者保守治疗效果不佳,如无手术禁忌证应及时行瓣膜置换术。Objective To explore the outcome of reoperation in patients with severe mechanical hemolytic anemia （MHA） after valve repair. Methods Twenty-eight patients with severe MHA after valve repair were divided into operation group （n=16） and conventional treatment group （n= 12）. Conventional treatment group received cardiac after- load reduction, alkalization of urine, iron supplementation and blood transfusion for correcting anemia, and operation group received valve replacement besides the conventional treatment. Results In conventional treatment group, 2 patients with surgical contraindications died of acute renal failure, and 7 died from no timely diagnosis and treatment. In operation group, 3 patients died of acute renal failure or upper gastrointestinal hemorrhage after mitral valve replacement. The remained survived patients were followed up for 1 month to 11 years. In conventional treatment group, echocardiogram in 2 years after operation presented severe mitral regurgitation in 1 patient and normal in 2 patients, and cardiac function was level Ⅰin 2 patients and level Ⅱ in 1. In operation group, 13 patients survived in the final follow-up survey with cardiac function level Ⅰ in 8 patients and level Ⅱ in 5, in which 1 patient had mild renal insufficiency on discharge and normal renal function in 3 months of follow up. Conclusion Conventional treatment can not achieve a satisfactory result for the patients with severe MHA after valve repair, therefore it is better to perform valve replacement if the patients have no surgical eontraindications.

关 键 词：机械性溶血性贫血 心脏瓣膜病 二尖瓣成形术 瓣膜置换术 

分 类 号：R654.2[医药卫生—外科学]