人工机械瓣膜置换术后患者的社区康复管理

Community-based Rehabilitation and Health Management in Patients with Mechanical Heart Valve Replacement

目的探讨社区康复管理在防治人工机械瓣膜置换术后患者远期并发症中的意义。方法 2001年2月—2012年7月,共计83例金属瓣膜置换患者在杨柳湾镇中心卫生院建立健康档案,接受系统的健康宣教、定期体检、并发症判断和处理。结果随访至2013-05-01,本组患者死亡3例(3.6%),死亡原因为肺癌、创伤、胃癌各1例,无一例因心脏瓣膜病或相关并发症死亡;总抗凝达标人数79例(95.2%);出血倾向8例(9.6%),经颅脑磁共振成像(MRI)诊断脑出血1例(1.2%);出现心功能Ⅱ级3例(3.6%)(肺部感染诱发1例,贫血诱发1例,过度劳动诱发1例),均在心功能恶化至Ⅲ级之前发现并就医,无心源性休克发生;新发心房纤颤3例(3.6%),原心房纤颤加重明显影响血流动力学2例(2.4%);原心房纤颤患者出现室性心律失常1例(1.2%),为感染性心内膜炎患者。结论社区康复管理在防治人工机械瓣膜置换术后患者远期并发症中有重要意义。

Objective To explore the significance of community- based rehabilitation and health management in pre- venting and treating long - term complications after mechanical heart valve replacement. Methods During February 2001 to July 2012, 83 prosthetic valve implanted patients were included and their health archives were established. All the patients included were given health education, periodic physical examination and complication diagnosis and treatment. Results Follow - up to May 1 st, 2013, of the 83 patients, no one died of valve disease or complications but three patients （3.6%） died of lung cancer, trauma and gastric cancer respectively; 79 patients （95.2%） reached the presupposed anticoagulation standard; 8 patients （9.6%） experienced hemorrhagic tendency and one patient were diagnosed as encephalorrhagia by using MRI; 3 patients （ 3.6% ） were diagnosed as cardiac function NAHY grade Ⅱ and their heart failure was induced by pneumonia, anemia and over- work respectively, but no cardiac shock occurred; 3 patients （3.6%） were diagnosed as atrial fibrillation for the first time and 2 patients （2.4%） experienced worsened atrial fibrillation that obviously influenced haemodynamics; One patient （ 1.2% ） ex- perienced ventricular arrhythmias following the infective endocarditis. Conclusion Community - based rehabilitation and health management is of great significance for preventing and treating the long - term complications after prosthetic valve replacement.