心脏瓣膜病合并肺动脉高压手术疗效观察

Effects of valve operation in patients with valvular heart disease complicated with pulmonary hypertension

目的观察瓣膜外科手术（瓣膜置换和/或瓣膜成型）对合并有肺动脉高压的瓣膜病患者的治疗效果。方法回顾2012年1月至2014年3月60例合并肺动脉高压的瓣膜病患者的临床资料。观察患者手术前后心功能等级、血流动力学变化,分析不同临床特征患者的预后。结果术前心功能Ⅲ-Ⅳ级患者,术后的心功能明显改善（P〈0.05）;接受手术的60例患者中共有2例死亡,死亡率为3%,共20例患者出现相关并发症;心功能Ⅲ-Ⅳ级患者的CVP、MAP、CI、PVRI、PAP和LVEF指标,手术前后差异有统计学意义（P〈0.05）;联合瓣膜病患者并发症的发生率明显高于单瓣膜病患者,肺动脉压力越高并发症发生率越高（P〈0.05）,2例死亡患者均是重度肺高压。结论心脏瓣膜病患者肺动脉压力与手术并发症高度相关,术前肺动脉压力评估应作为手术适应证的一项参考指标。

Objective To observe the therapeutic effects of valve operation（valve replacement or valve forming） in patients with valvular disease and pulmonary hypertension. Methods The clinical data of 60 patients with valvular disease complicated with pulmonary hypertension from January of 2012 to March of 2014 were retrospectively analyzed. The cardiac function and hemodynamics were observed before and after surgery,and the prognosis of patients with different clinical characteristics were analyzed. Results The patients with type Ⅲ and Ⅳ heart function grade before operation had better cardiac function after operation. In 60 patients underwent surgery,2 patients died,the mortality rate was 3%,a total of 20 patients with related complications. The levels of LVEF,MAP,PAP,CI,PVRI and CVP in patients with type Ⅲ and Ⅳ heart function had significant differences between before and after operation. The incidence of complications in patients with combined valvular disease was significantly higher than patients with single membrane disease,and the higher pulmonary artery pressure,the higher the complication rate（ P〈0. 05）,2 patients both died of severe pulmonary hypertension. Conclusion The pulmonary arterial pressure in patients with heart valve disease was highly correlated with the surgical complications,and preoperative pulmonary arterial pressure assessment should be used as a reference index for surgical indications.