风心病伴脑栓塞患者行瓣膜替换术的术中处理

Management of intraoperative period of valve replacement for patients with rheumatic heart disease and cerebral embolisme

目的对风心病伴脑栓塞患者行瓣膜替换术的术中处理措施进行临床经验总结,提高针对该类患者的治愈水平。方法回顾性分析2006年1月~2009年2月共17例风心病伴脑栓塞患者的临床资料,及瓣膜替换术的术中处理方法,术后并发症和死亡率。结果术后出现非神经系统并发症7例,其中低心排综合征3例,严重右心衰竭1例,肝功能重度减退2例,肾功能衰竭1例,并且有6例患者出现过心律失常。术后出现神经系统并发症4例,主要表现为精神异常、癫痫发作、短时间的昏迷,其余患者术后肢体功能障碍,语言障碍与术前比较无明显变化。围手术期死亡2例,其中死于术后低心排1例;脑栓塞昏迷并发呼吸衰竭和多脏器功能衰竭1例。通过门诊随访15例患者中的13例,6个月~18个月,总随访率86.7%,在随访期间无死亡,心功能（NYHY）Ⅰ~Ⅱ级,未再出现新的脑栓塞。结论风心病合并脑栓塞患者,经恰当的建立体外循环和掌握特殊的手术操作技巧,能达到较好的近、远期治疗效果。

Objective To analyze the measurements of patients with rheumatic heart disease and cerebral embolism during operation and improve their therapeutic effects.Methods Retrospective analysis clinic date of 17 patients with rheumatic heart disease and cerebral embolism from Jan,2006 to Feb,2009.Results 7 patients were found non-nervous system complication.Among them,3 patients had low cardiac output syndrome.1case had severe right heart failure.2 cases appeared abnormal liver function severe,1 case appeared renal failure and 6 cases suffered arrhythmia.4 patients had nervous system complications like emotional anomaly,epileptic attack.1 case died from low cardiac output syndrome and 1 case died from cerebral embolism with respiratory failure MODS.The total follow-up rate was 86.7%.Conclusions Patients with rheumatic heart disease and cerebral embolism can achieve good and long-term treatment effect by the appropriate establish extracorporeal circulation and grasp special operation skill.