58例重症心脏瓣膜病的围手术期处理

The Perioperative Treatment Experience of Severe Cardiac Valve Disease in 58 Cases

目的总结重症心脏瓣膜病的外科治疗结果,探讨提高早期生存率的围术期处理措施。方法自2002年1月~2009年1月,对58例重症心脏瓣膜病患者施行瓣膜替换术。二尖瓣置换30例,二尖瓣carptetier成形环成形2例,主动脉瓣置换8例,二尖瓣及主动脉瓣置换18例,同期行三尖瓣成形32例,左房折叠11例,左房血栓清除9例,冠状动脉搭桥术1例。结果本组术后早期死亡3例（死亡率5.17%）,低心排综合症、心律失常、多器官功能衰竭各死亡1例。结论对重症心脏瓣膜病患者,改善术前心功能,掌握手术时机,注重术中心肌保护,术中合理纠正瓣膜病变,加强术后监护,预防术后并发症,可提高手术成功率。

Objective To summarize retrospectively the experience of surgical treatment of 58 patients with severe cardiac valve disease,finding out the treatment to decrease the motality rate in perioperative period.Methods 58 patients with severe cardiac valve disease were under gone valve replacement operation from January 2002 to January 2010.In all of them,mitral valve replacement was performed in 30 cases;mitral valve annuloplasty in 2 cases;aortic valve replacement in 8 cases;both mitral and aortic valve replacement in 18 cases;and concomitant tricuspid annuloplasty in 32 cases,coronary artery bypass grafting in 1 case.Results The mortality rate was 5.17%（3/58） post-operatively early because of low cardiac output syndrome,continuous ventricular arrhythmia and multiple system organ failure respectively.Conclusion Surgical treatment for severe cardiac valve disease should include following measures,emphasizing the management during perioperative period,appropriately operative chance,correcting pathological changes,stengthening the myocardial prevention and the treatment of postoperative complications and follow-up post operation.It could reduce the mortality.