重症心脏瓣膜病人瓣膜置换72例临床分析

Experience of Cardiac Valve Replacement in 72 Serious Patients

【目的】探讨重症心脏瓣膜病人瓣膜置换的手术治疗和围术期处理。【方法】1997年1月至2005年12月重症心脏瓣膜病人72例接受手术治疗，其中男35例，女37例，年龄18～68岁，术前心功能Ⅲ级28例，Ⅳ级44例。二尖瓣置换39例，其中5例为再次手术，主动脉瓣置换8例，二尖瓣＋主动脉瓣置换25例，其中再次手术2例。同时施行三尖瓣成形51例，左房血栓清除15例，左房成形12例，冠状动脉搭桥2例。【结果】早期死亡5例（6．9％），低心排血量综合征、室性心律失常、呼吸衰竭及多器官功能衰竭是主要并发症。【结论】重症心脏瓣膜置换应注重术前准备，适当选择手术时机，合理纠正病变及加强术后并发症处理可进一步提高手术疗效。

[Objective]To summarize the experience of surgical treatment for critical cardiac valve diseases and perioperative management. [Methods]Seventy two patients with critical cardiac valve diseases underwent valve replacement from January 1997 to December 2005. There were 35 males and 37 females, with age range from 18 to 68 years . Preoperative heart function （NYHA） ： 28 cases in class Ⅲ , and 44 cases in class Ⅳ. Mitral valve replacement was performed in 39 cases within which closed mitral commissurotomy had been done before valve replacement in 5 cases. Aortic valve replacement was performed in 8 cases, both mitral and aortic valve replacements were performed in 25 cases within which closed mitral commissurotomy had been done before valve replacement in 2 cases. Associated procedures were tricuspid annuloplasty in 51 cases, left atrium thrombectomy in 15, left atrial annuloplasty in 12, and coronary artery bypass grafting in 2 cases. [Results] The early death occurred in 5 cases（6.9 %）. Low cardiac output, ventricular arrhythmia, respiratory failure and multiple system organ failure（MSOF） were the most frequent cause of mortality. [Conclusion] Surgical treatment for critical cardiac valve diseases should be performed after careful preoperative preparation, choosing appropriate operative chance, correcting pathological changes and strengthening management of postoperative complication may bring about an excellent result in serious patients.