重症心脏双瓣膜置换术26例治疗体会

Double valve replacement for severe valvular heart disease

目的：总结重症心脏双瓣膜置换术的临床治疗经验,分析术后主要并发症的诱因。方法：回顾性分析26例重症心脏双瓣膜置换术患者的临床资料。结果：围手术期并发症死亡2例（7.7%）,其中肾功能衰竭死亡1例,严重心律失常并多器官功能衰竭死亡1例。2例患者术前心功能Ⅲ~Ⅳ级,心胸比≥0.80,左心室舒张末内径（LVEDD）≥80 mm,术中心脏阻断时间及体外循环时间过长。结论：重症心脏双瓣膜置换术并发症与术前心功能、心胸比及术中心脏阻断时间、体外循环时间等因素有关。术前应改善心功能,术中注意心肌保护和选择合理的术式,术后加强围手术期的监测,降低并发症的发生率,提高患者存活率。

Objective：To summarize the clinical experience of double valve replacement and analyze main cause for complication.Methods： Clinical data of 26 cases with severe valvular heart disease was retrospectively analyzed.Results： Two died of perioperative complication（7.7%）,including 1 with renal failure and 1 with arrhythmia and multiple organ failure.Two cases had heart function at Ⅲ-Ⅳ stage,the cardiothoracic ratio ≥0.80,left ventricular end diastole diameter（LVEDD） ≥80 mm,and longer time of heart block and of extraeorporeal circulation. Conclusions： The occurrence of complication is associated with heart function before surgery, cardiothoracie ratio, heart block time during surgery and time of extra- corporeal circulation. Improvement of heart function before surgery, myocardial preservation, reasonable operative mode and perioperative monitoring are important.