人工机械瓣功能障碍的原因及治疗

Causes and treatment of artificial mechanical valve dysfunction

目的 探讨人工机械瓣功能障碍的原因及治疗方法,总结治疗经验.方法 2001年11月至2013年12月,我科共完成人工机械瓣膜置换术614例,有5例患者因机械瓣功能障碍再次住院,发生率0.81％,其中3例患者接受再次瓣膜置换术,2例患者要求保守治疗.5例患者均为女性,年龄35～48岁（中位数42岁）.手术在全麻低温体外循环下进行.3例患者手术方式为二尖瓣置换术＋三尖瓣成形术,2例要求保守治疗的患者经静脉持续泵人替罗非班12.5 mg/d及口服沙格雷酯治疗.手术或保守治疗后1周复查心脏彩超评估.结果 5例患者机械瓣功能障碍的原因均为未正规服用华法林抗凝导致瓣膜血栓形成.1例保守治疗患者死亡,1例保守治疗患者好转出院,3例接受手术患者痊愈出院.死亡患者死因为心功能衰竭,4例存活患者无严重并发症.结论 人工机械瓣功能障碍是机械瓣置换术后严重并发症之一.机械瓣功能障碍的原因多为瓣膜血栓形成,诊断明确后应积极治疗,手术治疗效果明确。

Objective To study the causes and treatment of artificial mechanical valve dysfunction, sum up the experience. Methods From November 2001 to December 2013, 614 patients were accepted artificial me- chanical valve replacement, 5 patients required rehospitalization because of artificial mechanical valve dysfunction, 3 patients were accepted operation of mitral valve replacement and tricuspid valvuloplasty, 2 patients were unoperated. Echocardiography was required after 1 week. Results The cause of artificial mechanical valve dysfunction was mechanical valve thrombosis because of taking warfarin inaccurately, 1 patient with conservative method died of heart failure, 1 patient with conservative method improved, 3 patients were accepted operation recovered. Conclusion Artificial mechanical valve dysfunction was one of serious complications after artificial mechanical valve replacement, one of the causes were mechanical valve thrombosis, active surgical intervention was required when diagnosis established.