再次心脏手术对策分析

Study of Countermeasure of Cardiac Re-operation

目的探讨再次心脏手术的处理方法及手术风险,研究制定相应对策。方法对30例心脏病患者行再次手术治疗。按首次手术类型分两组：介入手术组13例均行二尖瓣球囊扩张术;外科手术组17例,包括二尖瓣闭式扩张术8例、二尖瓣机械瓣置换术5例、室间隔缺损修补术4例。再次手术方式为：单纯二尖瓣置换术17例,二尖瓣并主动脉瓣置换术4例,二尖瓣二次置换术2例,二尖瓣口血栓清除术1例,单纯三尖瓣成形术2例,室缺残余漏修补4例。两次手术间隔时间1月~15年,平均（6.8±7.9）年。结果介入手术组再次术后无严重并发征及死亡发生;外科手术组再次术后出现低心排综合征4例、术后出血3例、严重心律失常3例,其中2例死亡。首次手术为介入组的转机时间、呼吸机辅助时间均短于外科手术组（P〈0.05）;而两组在低心排综合征、术后出血、严重心律失常的发生率及死亡率等方面比较无差异（P〉0.05）。结论首次心脏外科手术病例,其再次手术风险高、难度大。应充分认识心脏再次手术的危险性,术前应对危险因素、手术指征及手术时机分析评估,制定相应对策,运用良好心肌保护、灵活有效的技术手段及减少出血等措施,有利于提高手术成功率。

Objective To discuss and summarize the countermeasure of the cardiac re-operation.Methods The medical records of 30 cases of cardiac re-operation were analyzed from October 2001 to October 2007.All the patients were divided into two groups according to the first operations： the interventional group including percutaneous balloon mitral valvoplasty in 13 cases,and the surgical group including mitral valve closed expansion in 8 cases,mitral valve replacement in 5 cases,and repair of ventricular septal defect in 4 cases.The second operation included 17 cases of mitral valve replacement,4 of mitral valve and aortic valve replacement,2 of mitral valve re-replacement,1 of mitral valve thrombectomy,2 of tricuspid annuloplasty and 4 of direct remnant prothesis of VSD.The duration between two operations was 1 month to 15 years,（6.8±7.9） years in average.Results There was no severe complication in the interventional group.And in the surgical group,there were 4 cases of low cardiac output syndrome,3 of postoperative bleeding,3 of serious cardiac arrhythmias.1 case of low cardiac output syndrome and 1 case of bleeding died.Conclusions It is critical in cardiac re-operation,especially,in cardiac valve surgery and direct remnant prothesis of VSD.The physical condition of patients should be improved as better as possible before re-operation.It is important of myocardial protection,prevention of bleeding and appropriate use of drugs for improving the surgical efficacy.