降低心脏瓣膜替换术早期死亡率的探讨

Measures for decreasing the early mortality after valvular replacement cardiovascular Surgery

作者分析了１９９０～１９９５年的１２１５例心脏瓣膜替换术后死亡４４例的原因，以求探讨降低术后早期死亡的有效措施。作者认为：（１）术前积极改善心功能，防治心律失常；（２）注意术野的充分显露和心肌保护，尤其是再手术患者；（３）主张使用膜肺；（４）及时纠正术后低心输出量综合征，使用血管活性药物或主动脉内球囊反搏；（５）积极防治术后心律失常；（６）加强术后监护及综合治疗措施等均为提高重症瓣膜手术成功率的诸因素。

To probe the effective measure for decreasing the early mortality after artificial valvular replacement.We analyzed the cause of death among 1215 patients receiving artificial valvular replacement who were admitted in our intensive care unit during 1990￣1995.All 44 deaths were serious illed patients with preoperative cardiac functions of 3￣4 degree.The factors affecting surgical survival rate include:enhancement of patient′s cardiac function before operation and prevention of cardiac arrhythmia; a clear operational view and myocardial protection,especially for reoperative patients; application of membrane oxygenator ;treatment of LCOS without delay,including intraveously administered agents and IABP used promptly when necessary; prevention and treatment of postoperative cardiac arrhythmia;strict,intensive care and synthesized treatment.