心脏瓣膜转换术后患者住院死亡原因分析

Analysis of the patient's death cause in hospital after cardiac valve replacement

目的 :分析患者心脏瓣膜转换术后住院期死亡的原因和相关因素。方法 :全组均在全麻低温体外循环 (CPB)下行瓣膜置换术。结果 :患者总死亡率 9.9% ,死亡原因 :(1)低心输出量综合征是本组首位并发症和死因 (2 .6 % ) ,它与术前心功能 ( 级 ) ,L XEDD>8.0 cm、L VEF<0 .4、CTR>80 %、急诊手术、心肌保护差、主动脉阻断时间长等密切相关 ;(2 )术后室速、室颤是本组第二位死因 (2 .1% ) ,表现为突然发生 ,反复发作 ,十分顽固 ;(3)呼吸衰竭 ;(4 )术后出血致心包填塞、休克 ;(5 )术后移植瓣感染和脑部并发症。结论 :严格选择病例 ,改进手术操作 ,加强围术期监测、抢救 ,有望提高手术成功率。

Objective:The aim of our study was to analyse the death cause and related factors of death in hospital of patients after cardiac valve replacement(CVR).Methods:Regression analysis of 34 patients' data was executed. Results:Death rate was 9 9%,death cause:(1) Low cardiac output syndrome is the first complication and death cause(2 6%),which was closely related to cardiac function(grade Ⅳ) before operation,LVEDD>8 0 cm,LVEF<0 40,GR>80%,emergency operation,long time of arterial block,etc;(2)Ventricular tachycardia、ventricular fibrillation is the second cause of death(2 1%);(3)Respiratory failure(4)Post\|operation hemorrhage inducing pericardial tamponade and shock;(5)Postoperation infection of replaced valve and brain complications.Conclusion:The success rate of operation can be increased by selecting patients strictly,improving operation methods,enhancing periopertive monitor.