心脏瓣膜置换术围手术期处理76例分析

Perioperative Management Experience of Cardiac Valve Replacement in 76 Cases

目的总结76例心脏瓣膜置换术围手术期处理经验。方法选取2002年6月—2005年6月行瓣膜置换术76例,均为风湿性二尖瓣和(或)主动脉瓣病变,分别行单瓣或双瓣置换术。其中二尖瓣置换术53例,主动脉瓣置换术11例,二尖瓣与主动脉瓣联合置换12例。浅低温不停跳手术22例,中低温停跳手术51例。结果73例患者安全度过围手术期,术后早期死亡3例,占3.96%。死亡原因主要为多脏器功能衰竭,术后并发症主要为严重低心排出量综合征、恶性心律失常、呼吸功能或肾功能严重损害,以及多脏器功能衰竭。结论重视围手术期处理:调整全身及心功能达到最佳状态,术中良好心肌保护、缩短主动脉阻断时间,或采用浅低温不停跳技术,同时纠正三尖瓣病变,术后积极防治低心排血量、室性心律失常和多器官功能衰竭是手术成功的关键。

Objective To analyze the perioperative management experience of cardiac valve replacemen in 76 cases. Methods Between Jan, 2002 to July, 2005, 76 patients were operated with cardiac valve replacement, including mitral valve in 53, aortic valve in 11, and combined mitral and aortic valve in 12. All the patients were ill with rheumatic valve diseases. In the group, 22 patients underwent heart-beating operation and 51 ones underwent arrested heart operation. Results Seventy-three patients underwent perioperative period＇ smoothly. Three patients died in the early stage of operation. The early mortality was 3.96%. The ealry death＇s main reason was multiple organ disfuction syndrome （MODS）. The main cause of the complications were low cardiac output syndrome, ventrieular arrhythmia, respiratory and renal failure, and MODS. Conclusion Succeeding in surgical therapy lies on proper perioperative care, i.e. improvement in physical condition particulary in cardiac function, myocardial protection during the operation, decrease in the time of aortic clamp and application of mild hypothennia heat-beating method. Furthermore, postopera, tivcly avtive treatment or prevention against low cardiac output syndrme, ventriular arrhythmia and multiple organ failure （MOF） during perioperation should be emphasized, tion against and treatment of low cardiac output syndrme, ventriular arrhythmia and multiple organ failure （MOF） in perioperation should be edasized.