心脏瓣膜置换术89例治疗体会

Experience on 89 patients undergoing cardiac valve replacement

目的:总结心脏瓣膜置换术89例的疗效,探讨严格掌握手术适应证,加强围手术期处理在提高手术疗效中的重要性。方法:为89例心脏瓣膜病行心脏瓣膜置换术,其中双瓣置换术25例,二尖瓣置换术60例,主动脉瓣置换术4例;同时行三尖瓣Devega成形术6例,均选用机械瓣。结果:术后早期病死8例,其中并发低心排血量综合征、肾衰竭、多器官功能衰竭病死5例,并发恶性室性心律失常病死3例,病死率为9.0%,生存81例,术后6个月时心功能明显改善。结论:提高手术疗效,降低手术并发症及病死率的关键是严格掌握手术适应证及完善的围手术期处理。

Objective：To summarize the curative effect of 89 patients undergoing cardiac valve replacement and to discuss the importance about grasping strictly indications of operation and perioperative management in enhancement of operative effect. Methods ： Eighty-nine patients were operated with cardiac valve replacement including mitral valve in 60, aorta valve in 4, and combined mitral valve and aorta valve in 25. Among them,6 patients underwent tricuspid valve Devega plastic surgery and the mechanical valves were used in all patients. Results：Early death occurred in 8 patients. Five patients died of acute renal failure, low cardiac output syndrome and multiple organ failure. Three patients died of malignant arrhythmia. The death rate was 9.0%. Eighty-one patients survived and after 6 months heart the function improved significantly. Conclusions：The key to enhance the curative effect of the surgery, decrease the surgery complications and the death rate is to control strictly indications of operation and to perfect the perioperative management.