心脏瓣膜置换术后多器官衰竭的救治（附53例报告）

Treatment of MSOF after heart valve replacement:ananalysis of 53 cases

作者报告了５３例心脏瓣膜置换术后多系统器官衰竭（ＭＳＯＦ）的救治经验。其中二尖瓣置换术后２０例，主动脉瓣置换术后６例，二尖瓣合并主动脉瓣置换术后２７例。术前心功能Ⅱ级５例，Ⅲ级１７例，Ⅳ级３１例。均于术后第２～７天出现ＭＳＯＦ，衰竭的系统器官包括心、肺、肾、肝、脑、胃肠道以及凝血系统，数目最多者达６个。抢救存活３６例，１７例（３２．１％）死亡。死亡率与衰竭系统器官的数目呈正相关（ｒ＝０．９６０，Ｐ＜０．０１）。序贯发生ＭＳＯＦ组死亡率２８．２％（１１／３９），显著低于同时发生ＭＳＯＦ组的４２．９％（６／１４）（Ｐ＜０．０５）。心功能Ⅳ级的ＭＳＯＦ患者死亡率显著高于心功能Ⅱ、Ⅲ级组（Ｐ＜０．０１），手术类型对ＭＳＯＦ的死亡率无显著影响。文中对心脏瓣膜置换术后ＭＳＯＦ的产生原因及救治措施进行了讨论。

AbstractWe treated 53 patients with multiple system organfailuse ( MSOF) following heart valve replacement.MVR was performed in 20 cases, AVR in and DVRin 27. Before operation , NYHA functional class Ⅱ wasin 5,Ⅲ in 17, and Ⅳ in 31. MSOF of all 53 patientsoccurred within 2～7 days after operation, and failingorgans involved heart, lungs, kidneys, brain, gas-trointestinal and blood coagulation system. The pa-tients with the maximum organ failure had 6 failing or-gans, 36 of the 53 patients were living and 17(32.1% ) died. The mortality correlated positivelywith the number of failing organs. The results ofMSOF which occurred sequentially were better com-pared with those occurred simultaneously. The deathrate in patients with class Ⅳ was higher than that inthose classⅡ, Ⅲ. The type of operation (MVR,AVR, DVR) did not effect the result of MSOF. The-causes and management of MSOF after heart valve re-placement were discussed.