瓣膜病合并心脏恶液质的外科治疗

Surgical treatment of cardiac cachexia in valve diseases

目的总结瓣膜病合并心脏恶液质(SOCC)的外科治疗体会。方法总结上海交通大学医学院附属仁济医院1996年1月至2005年12月行917例瓣膜手术,其中SOCC患者90例。结果SOCC组90例病例,死亡6例,死亡率6.7%,死亡原因为低心排、呼吸衰竭、恶性心律失常、DIC、多脏器功能衰竭。非SOCC组827例,死亡率4.8%。结论瓣膜病合并心脏恶液质患者的术前准备,手术时机的选择,术中三尖瓣的处理,术后低心排的处理,围术期营养支持和多脏器功能的维护很重要。

Objective To summarize the surgical management of SOCC in valve diseases. Methods To review the 917 cases from Renji hospital affiliated to the medical college of Shanghai Jiaotong University betwecn Jan 1996 and December 2005. There are 90 cardiac cachexia patients received the operation. Results 6 of 90 patients died after the operation.The mortality is 6.7% .The reasons are low cardiac output syndrome （LCOS） ,respiratory failure, refractory arrhythmias, DIC and MOSF.Meanwhile,there are 827 patients without SOCC and the mortality of non-SOCC is 4.8%. Conclusion Full preoperative preparation, timing of operation, management of tricuspid valve, postoperative LCOS, perioperative nutrition and protection of multi-organs are very important for cardiac cachexia patients.