重症心脏瓣膜病的外科治疗

Surgical Treatment of Severe Valvular Heart Disease

目的 提高重症心脏瓣膜病人瓣膜替换术的手术疗效。方法 回顾性分析 2 97例重症瓣膜病瓣膜手术病人。术前平均LVd(A -P) 5 9.9± 13 .8mm(其中 >70mm 69例 ,占 2 3 .2 % ) ,LAs(A -P) 60 .2± 16.6mm(其中 >60mm13 3例 ,占 44 .8% ) ,LVFS 2 9.0 %± 8.4% ,LVEF 5 4.9%± 13 .4% ,C T 0 .66± 0 .0 9。结果 二次开胸 8例 (2 .7% ) ,低心排综合征 16例 (5 .4% ) ,肺功能不全 2 6例 (2 .0 % ) ,肝功能不全 5例 (1.7% ) ,肾功能不全 6例 (2 .0 % ) ,脑合并症 4例 (1.3 % ) ,急性胰腺炎 1例 (0 .3 % ) ,瓣周漏 3例 (1.0 % ) ,心包积液 16例 (5 .4% ) ,死亡 4例 (1.3 % )。术后 10 -14天 ,UCG复查LVd(A -P) ,LAs(A -P) ,C T较术前显著缩小 ,而LVFS和LVEF有所减少。结论 保留二尖瓣装置 ,双瓣置换术中人工瓣膜的合理选择和匹配 ,合并三尖瓣病变的处理 ,采用含血停跳液温冷温顺序灌注 ,加强术后处理是提高重症心脏瓣膜病瓣膜替换术疗效的重要措施。

Objective: In ordrr to improve the results of valve replacement for the patients with severe valvular heart disease.Methods:A retrospective study was carried out review experience.297 cases with severe valvulat heart disease underwent valve replacement operation.Preoperatively,the LVd(A-P)was59.9±13.8mm(>70mm in 69,23.2%)LAs(A-P)60.2±16.6mm(<60mm in 133,44.8%),LVFS 29.0%±8.4%,LVEF 54.9%±13.4%,C/T 0.66%±0.09 . Results: Early postoperative complication included:Re-open in 8(2.7%),LCOSin 16(5.4%),respiratory insufficiency in 6(2.0%),hepatic dysfunction in 5(1.7%),renal insufficiency in 6(2.0%),complication of CNS in 4(1.3%),acute pancreatitis in 1(0.3%),periprosthetic leakage in 3(1.0%),pericardia effusion in 16(5.4%)and death in 4(1.3%). On 10 th -14 th post-operative day, UCG showed that LVd(A-P),LAs(A-P)and C/T were decreased significantly (P<0.05%),but LVFS and LVEF also decreased. Conclusion:MVR with preservation of valve and the subvalvular structures, correct selection of artificial valves in DVR , TVP with TR,utilizing warm blood cardioplegia (warm-cool-warm)and enhancing post-operativce treatment can significantly improve the results of valve replacement for the patients with severe valvular heart disease.