重症心脏瓣膜替换术56例分析

Clinical analysis of valve replacement of 56 cases with severe heart valve diseases

探讨重症心脏瓣膜替换术的手术时机、手术方式、瓣膜选择和心肌保护。方法采用中度低温（２５℃～２８℃）体外循环直视手术，共置换生物瓣１２枚，机械瓣４８枚，其中二尖瓣替换４３例，主动脉瓣替换４例，主动脉瓣和二尖瓣同时替换８例，三尖瓣替换１例。结果心功能明显改善者４６例且长期生存，心胸比率由平均０．７４降为０．５８（Ｐ＜０．０５）。早期死亡８例（１４．２８％），晚期死亡２例。结论合适的手术时机、手术方法。

Objective The indication, method, valve choice and myocardiac protection of valve replacement operation were reviewed. Methods Medianhypothermia with extracoporeal circulation was applied for the replacement of 12 biovalves and 48 mechnical valves including the replacement of 43 mitrals, four aortic valvess, eight mitral and aortic vales and one tricuspid valve. Results 46 cases showed obvious improvement of cardiac function and longterm survival. The mean cardiothoracic ratio decreaded from 074 to 058 (P<005). There were eight patients who died in the hospital (1428%) and two patients died late. Conclusions The operative indication, method, valve choice and myocardiac protection were strongly related to the cardiac valve prothesis.