16例心脏瓣膜置换术后患者死亡原因分析

Analysis of reasons leading to death of 16 cases underwent cardiac valvular replacement

目的分析心脏瓣膜置换术后患者围手术期死亡原因，探讨降低死亡率的措施。方法对1998年10月至2012年3月我科施行的心脏瓣膜置换术后16例围手术期死亡患者的死亡原因进行回顾性总结和分析。结果术中死亡4例，包括低心排出量综合征（LCOS）不能停体外循环2例，主动脉口血1例，早期左心室破裂1例。其他12例死于术后3h至27d，其中LCOS4例、迟发型左心室破裂2例、肾功能衰竭2例、呼吸功能衰竭2例、甲亢危像1例。结论术前进行有效的针对性治疗，术中尽可能缩短手术及体外循环时间，减少手术意外，积极、有效地预防和处理并发症的发生，是降低心脏瓣膜置换术后死亡率的关健。

Objective To analyze reasons leading to perioperative deaths of patients underwent cardiac valvular replacement and explore managements to decrease mortality. Methods We retrospectively analyzed and reviewed 16 patients died intra or after valvular replacement between October 1998 and March 2012 in our depart- ment. Results There were 4 patients died intraoperatively, including 2 cases with low cardiac output syndrome （LCOS） and not weaning off cardiopulmonary bypass, 1 case with aortic hemorrhage, and 1 case with early rup- ture of left ventricle. Another 12 patients died 3 hours to 27 days after valvular replacement, including 4 cases with LCOS, 2 cases with delayed rupture of left ventricle, 2 cases with renal failure, 2 cases with respiratory fail- ure, and 1 case with hyperthyroidism crisis. Conclusion It is key factors to decrease mortality of valvular re- placement to aim directly at improving cardiac and respiratory function effectively before operation, shorten dura- tion of operation and cardiopulmonary bypass as far as possible, avoid accidents intraoperatively, and to prevent and manage complications effectively and actively.