重症心脏瓣膜病的外科治疗

Surgical Treatment of Severe Valvula Heart Diseases:Report of 308 Cases

自１９８５年６月～１９９５年１月共收治重症心脏瓣膜病３０８例。重症病例判断标准为：（１）心功能Ⅳ级；（２）急诊手术；（３）心胸比率≥０．８０；（４）合并冠心病需行搭桥术；（５）ＬＶＥＤＤ≥８０ｍｍ或ＬＶＥＳＤ≥６０ｍｍ；（６）心导管检查ＣＩ≤２．０Ｌ／ｍｉｎ·ｍ２并ｍＰＡＰ≥９．５ｋＰａ或ＰＶＲ≥２０００ｄｙｎｅ·ｓ·ｃｍ－５；（７）三瓣膜置换术；（８）瓣膜再次置换术。结果：手术死亡３１例，死亡率１０．１％；远期随访２～９４月（平均３４月），远期死亡率３％／人·年。远期心功能Ⅰ、Ⅱ级２１５例，Ⅲ级１７例，Ⅳ级４例。讨论了手术指征，手术方法和围术期处理。

From Jun.1985 to Jan. 1995,308 cases of severe valvula heart diseases were surgically treated. The criteria were as follows: heart functional class Ⅳ, emergency operation, valve disease with coronary heart disease, cardiac index≤2.0/min·m 2 and mean pulmonary arterial pressure≥9.33kPa (70mmHg) or pulmonary vascular resistance≥2000 dyne s cm -5 ,left ventricular end diastolic diameter≥80mm or left ventricular endsystolic diameter≥60mm, secondary valve replacement, cardio thoracic ratio≥ 0.80, and tripple valve replacement. Thirty one patients died in hospital, the operative mortality was 10.1%, 90.2% of the operative survivals were followed up 2～94 months (average 34 months). Late mortality was 3%/per patient year. Two hundred and fifteen patients were in heart functional class Ⅰ or Ⅱ, 17 in class Ⅲ, 4 in class Ⅳ.The operative techniques and perioperative management are detailed.