改良左心减压在重症二尖瓣机械瓣替换术中的应用

Application of modified left ventricular decompression in severe mitral valve mechanical replacement

目的:探讨一种应用于重症二尖瓣替换术中的改良左心减压方法,并分析其疗效。方法:对14例重症二尖瓣患者行二尖瓣机械瓣替换术,术前均予以调整心功能治疗2周以上,术中应用改良左心减压方法。结果:14例患者均取得手术成功,术中顺利停体外循环机,10例心脏自动复跳,4例除颤后心脏复跳。术后均恢复良好,顺利出院。术后3周复查心脏彩超,患者射血分数较术前提高,左室舒张末内径及左房内径较前减小(P<0.05)。随访1～12月,患者心功能状态恢复良好,生活质量明显改善。结论:改良左心减压应用于重症二尖瓣替换术效果良好,有助于术中心肌保护,增加体外循环结束时心脏自动复跳机会,可减少术后低心排综合征发生率,具有较好的推广价值。

Objective:To explore an improved left ventricular decompression method for severe mitral valve replacement and analyze its curative effect.Method:The 14 patients with severe mitral valve replacement were treated with mechanical mitral valve replacement.All patients were treated with heart failure for more than 2weeks before operation.Modified left ventricular decompression was applied during all the operation.Result:All 14 patients were successfully operated.Cardiopulmonary bypass machine was stopped smoothly during the operation.The 10 patients had automatic cardiac resuscitation and 4patients had cardiac resuscitation after defibrillation.All patients recovered well and discharged successfully.Three weeks after operation,echocardiography showed that the ejection fraction increased,the left ventricular end-diastolic diameter and the left atrial diameter decreased(all P<0.05).Follow up in 1-12 months,the cardiac function recovered well,and the quality of life improved significantly.Conclusion:Modified left ventricular decompression is effective in severe mitral valve replacement,which is helpful to myocardial protection during operation,increases the chance of automatic cardiac resuscitation at the end of cardiopulmonary bypass,and reduces the incidence of postoperative low cardiac output syndrome(LCOS).