54例重症心脏瓣膜病的外科治疗

Surgical repair of severe cardiac valve disease in 54 cases

目的回顾性总结54例重症心脏瓣膜病的外科治疗经验。方法2002年4月至2006年9月,对54例重症心脏瓣膜病患者进行瓣膜置换手术。对其围手术期处理及术中特殊处理进行总结和分析。结果早期出现低心排综合征8例,其中2例并发多器官功能衰竭死亡,死亡率3.7%(2/54)。心包、纵隔引流多开胸止血3例,室颤3例,脑梗死1例。二尖瓣置换术后瓣周漏1例,半年后再手术。二尖瓣置换3年后出现下消化道出血1例。二尖瓣置换半年后出现SBE而行双瓣置换1例。结论重症心脏瓣膜病的外科治疗应注意围手术期处理,适当选择手术时机,合理纠正病变,防治术后并发症并加强术后随访。

Objective To summarize retrospectively the experience of surgical treatment of 54 patients with severe cardiac valve disease. Methods 54 patients with severe cardiac valve disease were underwent valve replacement operation from April 2002 to September 2006. Perioperative management and special treatment during operation were summarized and analyzed. Results There were 8 patients with early low cardiac output syndrome. In the group 2 ones died of multiple system organ failure, The mortality rate was 3.7%（2/54）.Three patients were re-operated for much volume of perieardial and allngeneie banded blood. There were 3 eases with ventrieular fibrillation, 1 with cerebral infarction, 1 with valve leak after MVR and re-operation half a year later, 1 with lower gastrointestinal hemorrhage 3 years after MVR, 1 with SBE half a year after MVR and re-operation. Conclusion Surgical treatment for severe cardiac valve disease should include following measures, emphasizing the management during perloperative period, appropriately operative chance, correcting pathological ehanges,stengthening the prevention and the treatment of postoperative complications and follow-up post operation.