重症风湿性心脏病瓣膜关闭不全的围术期处理  

The perioperative treatments of severe rheumatic heart disease with valve insufficiency

作　　者：柳克晔[1] 陈英淳[1] 尤斌[1] 苏丕雄[1] 李京倖[1] 孔晴宇[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科

出　　处：《中华胸心血管外科杂志》2003年第1期25-28,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨重症风湿性心脏病瓣膜关闭不全的围术期处理和依据。方法　选择风湿性二尖瓣或 (和 )主动脉瓣关闭不全 2 5例 (组 1)、瓣膜狭窄 17例 (组 2 )和单纯先天性心脏病 14例 (组 3)病人 ,观测手术前后收缩末期弹性模量 (Ees)、前负荷充盈性搏功 (PRSW)、心肌超微结构定量分析等指标。结果　Ees组 1术后低于术前 ;组 2术后略低。PRSW组 1术后明显低于术前 ,组 2手术前、后差异不明显。组 1术前前负荷增加 ,术后后负荷增加。心肌细胞胞密度 (Vc % )、肌原纤维体密度 (Vvmyo % )和线粒体体密度 (Vvmit% )组 1明显低于组 2。左室射血分数 (EF)组 1术后明显低于术前 ,组 2手术前、后相似。组 1死亡 1例。结论　瓣膜关闭不全型的风湿性心肌病理损害及心功能下降更为明显 ,心脏负荷及心肌作功反而增加。应加强容量控制和血管扩张药物使用 ,以术前减轻前负荷、术后减轻后负荷为主 ,适量使用强心药物。Objective: To study the perioperative treatments for severe rheumatic heart disease with valve insufficiency. Methods: Group 1 (n=25): mitral or/and arotic valve insufficiency, group 2 (n=17): valve stenosis and group 3 (n=14): simple congenital heart diseases. The load-independent index-end systolic elastance (Ees), pre-load recruited stroke work (PRSW), and the quantitive analyses of myocardial ultrastructure were observed and analyzed pre- and post-operatively. Results: Ees was lower after operation than before operation in group 1, and it was a bit lower after operation in group 2. PRSW was significantly lower after operation than before operation in group 1, and it was similar before and after operation in group 2. The pre-load before operation and after-load after operation in group 1 increased. Vc%, Vvmyo% and Vvmit% were significantly lower in group 1 than in group 2. Ejection fraction (EF) was significantly lower after operation than before operation in group 1, and it was similar before and after operation in group 2. One case of group 1 died. Conclusion: The pathological damages of rheumatic myocardium and the reduction of their heart functions were more significant in valve insufficiency group, but myocardial work and load increased. Therefore, the volume should be controlled, and with the relevant vasodilators to decrease, the pre-load before operation and after-load after operation effectively.

关 键 词：风湿性心脏病 心脏瓣膜疾病 围手术期 

分 类 号：R654.2[医药卫生—外科学]