高危心脏瓣膜疾患310例围术期处理

PERIOPERATIVE MANAGEMENT OF 310 HIGH RISK PATIENTS WITH VALVULAR HEART DISEASE

自1978年12月至1991年6月,为高危心脏瓣膜病病人施行瓣膜替换术310例。高危病人分为3个类型:(1)二尖瓣或合并主动脉瓣病变,引起左或右室功能严重障碍者(139例)。(2)二尖瓣与主动脉瓣病变合并三尖瓣器质性病变,引起左右心室双室功能障碍(19例)。(3)其他高危病人,包括二尖瓣病变合并其他重要脏器功能障碍(84例),风湿活动发作合并风湿性心肌炎(43例),瓣膜病变因各种原因发生血液动力学的急性改变,引起心原性休克(25例)。本组早期死亡32例(10.3％),其中心原性原因占56.2％,其他重要脏器功能衰竭占43.8％。

Three hundred and ten high risk patients with valvular heart disease were operated on in our hospital from December 1978 through June 1991. All the high risk patients were classified into three types: 1. those with mitral lesions, or combined with aortic lesions, and severe left or right ventricular dysfunctions (139 cases); 2. mitral lesions and aortic lesions combined with organic tricuspid lesions, and severe left and right ventricular dysfunctions (19 cases); 3. valvular lesions combined with dysfunction of other important organs and/or acute hemodynamic changes or cardiogenic shock (152 cases). Perioperative managements: Preoperatively digoxin, diuretics and vasodilator were used to improve the cardiac function and systemic state. During operation, myocar-dial protection, thorough correction of the cardiac valve lesions, and optimum and match of synthetic cardiac valve were emphasized. The major points of early postoparative care included mechanical assistant ventilation, the use of positive myocardial inotropic drugs, vasodilator and diuretics. There were thirty two early deaths (10.32%) postoperatively. Among them, 56.2% died of cardiogenic causes and 43.8% of dysfuntions of other important organs. This paper emphatically discussed the perioperative managements of high risk patients with valvular heart disease in an effort to improve the operative results.