降低失功能心脏生物瓣再手术死亡率的经验

Experience of Reoperation on Cardiac Bioprosthesestic Valve Dysfunction

总结１９８１年１０月至１９９４年１２月６０例生物瓣膜失功能病人再次行瓣膜替换术的经验。病人年龄１６～６２岁（平均３６．１±７．３岁）。两次换瓣间隔时间为２６～１６８个月（平均１０２．９±２４．６个月）。手术死亡７例，手术死亡率１１．７％。前期（１９８１年１０月至１９８５年１２月）死亡率５７．１％（４／７）；后期（１９８６年１月至１９９４年１２月）死亡率５．７％（３／５３）（Ｐ＝０．０００１）。结论：对生物瓣失功能病人应及早行再换瓣术、术前应积极改善心功能、术中勿过多游离心包粘连、注意心肌保护、术后重症低心排者积极采用主动脉内球囊反搏术等。上述措施可有效降低手术死亡率。

Sixty patients, aged 16～62 yearold with an average of 36±7.3 years,with bioprostheses dysfunction underwent reoperations from Oct, 1981-Dec,1994.The interval between two operations was 26～168 months (average 102.9±24.6 months).Overall mortality was 11.7%(7/60)In early years(Oct, 1981-Dec,1985),the mortality was 57.1%(4.7),and decreased to 5.7%(3/53)lates(Jan, 1986-Dec,1994) (P=0.0001).Conclusions:(1)Once significant valve dysfunction is noted reoperation should be undertaken;(2)Heart function should be improted maximally before operation;(3)Myocardial pro-tection during operation is of paramount importance; (4) Excessive dissection of pericardial adhesions should be avoided;(5) Intra-aortic balloon pumping for couuter pulsation should be contidesed as soon as severe low cardiac output appears.