心脏瓣膜替换术122例分析

ANALYSIS OF CARDIAC VALVE REPLACEMENT IN 122 CASES

本院自１９８４年３月至１９９２年１２月，应用侧倾碟瓣、牛心包生物瓣和Ｓｔ．Ｊｕｄｅ瓣施行心脏瓣膜替换１２２例。除１例外，病因均为风湿性病变。二尖瓣替换９６例，双瓣膜替换１７例，主动脉瓣替换９例。心功能（ＮＹＨＡ）Ⅲ级者７８例，Ⅳ级者２１例。术后１个月内死亡１５例（１２．３％）。死亡原因主要为心室颤动，细菌性、霉菌性心内膜炎，低心输出量综合征等。８３例随访６～９６个月，晚期死亡５例。余均症状改善，多数已恢复工作。本文还就换瓣手术指征，心室颤动的原因，重症患者机械呼吸的应用，术后心内膜炎等问题进行讨论。

From March 1984 to December 1992,122 patients had valve replacement of tilting disc prostheses, calf heterograft and St.Jude prostheses in our hospital.All of the patients were of rheumatic heart disease except one. Mitral valve was replaced in 96 cases,double valves in 17 and aortic valve in 9.Preoperative heart function was class III(NYHA) in 78 cases and class IV in 21.15 cases died postoperatively in the first month (mortality 12.3%). The main causes of death were ventricular fibrillation, bacterial and mycotic endocarditis and low cardiac output.83 cases were followed up for 6 to 96 months. There were 5 cases of late death. Symptoms of the survivors were all improved and the majority resumed work. The indications forvalve replacement,causes of ventricular fibrillation, application of mechanical respiration in critical patients, and postoperative endocarditis were discussed.