重症心脏瓣膜病围手术期治疗的临床分析

The clinical analysis of the peroperative period in severe valvular heart disease

目的 探讨重症心脏瓣膜病围手术期治疗方法.方法 回顾性分析2007年7月至2010年7月在本科实施瓣膜置换术的206例重症心脏瓣膜病患者的术前准备,术中、术后处理.其中单纯二尖瓣置换19例,二尖瓣置换加三尖瓣成形77例,二尖瓣置换加三尖瓣成形加迷宫手术24例,单纯主动脉瓣置换9例,主动脉瓣置换加升主动脉置换2例,二尖瓣加主动脉瓣置换加三尖瓣成形58例,二尖瓣加主动脉瓣置换加三尖瓣成形加迷宫手术10例,二尖瓣置换加冠状动脉旁路移植术2例,三尖瓣置换2例,再次手术置换二尖瓣3例.结果 死亡7例（低心排致多器官功能衰竭5例,左心室破裂2例）死亡率3.39%.电话、门诊随访185 例,随访时间4～40个月,心功能（NYHA）Ⅰ级47例、Ⅱ级128例、Ⅲ级10例.结论 对重症心脏瓣膜病患者,术前调整心功能,选择合适的手术时机,术中注意心肌保护,注意保留瓣下组织,术后使用必要的辅助手段,可提高手术成功率.

Objective To investigate the therapeutic method of the Peroperative Period in severe valvular heart disease. Methods To summarize the treatment of 206 inpatients, from July 2007 to July 2010 ,with severe valvular heart disease during the preoperotive,intraoperative and postoperative by retrospective analyze. Nineteen patients took mitral valve replacements. Seventy-seven patients took mitral valve replacements and tricuspid valve repairs. Twenty-four patients took mitral valve replacements, tricuspid valve repairs and maze. Nine patients took aortic valve replacements. Two patients took aortic valve replacements and ascending aorta replacements. Fifty-eight patients took double valves, （mitral valve and aortic valve）replacements and tricuspid valve repairs. Ten patients took double valves replacements,tricuspid valve repairs and maze. Two patients took mitral valve replacements and coronary artery bypass graft. Two patients took tricuspid valve replacements. Two patients took reoperative after mitral valve replace ments. Results Seven patients dead in the Peroperative Period muitiple,the mortality was 3.39% o One hundred and eight-five patients were followed up from 4 month to forty monthes,all patients recovered well. Conclusion It can increase the achievement ratio of the operation in the patients with severe valvular heart disease by some good therapeutic methods.