心脏不停跳下生物瓣膜置换术的临床研究

Clinical study on bioprosthesis valve replacement under beating heart

目的探讨浅低温心脏不停跳下生物瓣膜置换术的治疗效果。方法 242例心脏瓣膜疾病患者接受浅低温心脏不停跳下生物瓣置换术,其中心功能分级(NYHA)Ⅰ级15例,Ⅱ～Ⅲ级190例,Ⅳ级37例;心胸比例0.6～0.7者138例,0.5～0.6者55例,≥0.7者49例;合并心房颤动185例,合并糖尿病25例,感染性心内膜炎32例。行二尖瓣置换146例,其中三尖瓣成形36例;主动脉置换术22例;二尖瓣加主动脉置换49例;再次瓣膜置换25例。术后病人通过电话和门诊随访。结果本组病人住院期间死亡10例,死亡率为4%(10/242),术后心率过缓3例,并发呼吸道感染10例,低心排综合征4例,肾功能不全3例。术后随访190例,死亡5例,心功能恢复至Ⅰ～Ⅱ级175例,Ⅲ级10例。结论浅低温心脏不停跳下施行生物瓣膜置换效果良好,手术安全可行,尤其适用于重症瓣膜病变及巨大心脏者,值得在临床上进一步推广。

Objective To explore the therapeutic effect of bioprosthesis valve replacement under beating heart and mild hypothermia. Methods 242 cases of patients were underwent bioprosthesis valve replacement under beating heart and mild hypothermia, among them, 15 cases was NYHA Ⅰ, 190 Ⅱ - Ⅲ, 37Ⅳ ; 138 had a cardiothoracic ratio of,55 0.5 - 0.6, and 49 t〉0.7 ; 186 were complicated with atrial fibrillation, 25 diabetes mellitus, and 32 infective endoearditis; 146 cases were performed with mitral valve replacement （36 were tricuspid annuloplasty ）, 22 aortic replacement surgery, 49 mitral plus aortic replacement, and 25 re-valve replacement. Patients were followed up by telephone and outpatient clinic. Results 10 died during hospitalization,the mortality rate was 4% （10/242）. 3 bradycardia, 10 respiratory infection,4 low cardiac output syndrome,and 3 renal insufficiency were observed. Postoperative follow-up were receive in 190 cases, five died,175 cased were recorded with cardiac function recovered to grade Ⅰ - Ⅱ 175 ,and 10 to grade Ⅲ. Conclusion Bioprosthesis valve replacement under beating heart and mild hypothermia is showed with excellent therapeutic effect, safe, and feasible, especially for severe valvular disease and a huge heart, worthy of further promotion in clinical practice.