心脏人工机械瓣膜置换术635例

A Clinical Report on the Result of 635 Cases with Cardiac Mechanical Prosthetic Valve Replace-ments

目的 总结635例心脏人工机械瓣膜置换手术经验及围术期处理原则。方法 1981年12月至2002年6月共完成635例心脏瓣膜置换术,其中男性382例、女性253例,年龄11～63岁(32.4±10.70)岁。68.7％的患者术前心功能分级为NYHA Ⅲ～Ⅳ级,风湿性心脏病是首位病因。479例患者行二尖瓣置换,72例患者行主动脉瓣置换,84例患者行多瓣膜置换,合并冠状动脉旁路移植术1例,合并其它手术15 例。共植入人工机械瓣膜719例。结果 总死亡率9.10％(1997年前为14.5％,1997年后为4.1％)。主要死亡原因为低心排综合征、心律失常、肾功能衰竭。结论 尽可能完善的围术期处理以及良好的术中心肌保护是降低病死率的主要措施。

Objective To summarize the experience of 635 cases with cardiac mechanical prosthetic valve replacements and the management principles of perioperation. Methods 635 patients who suffered the heart valve disease were treated with the procedure of cardiac mechanical prosthetics valve replacements in our hospital from December ,1981 to June,2002.There were 382 males and 253 females, the mean age was 32.4±10.7 (11-63)years old. 68.7% of the patients the heart function were in NYHA Ⅲ-Ⅳ. Rheumatic heart disease was the leading etiology of this group. Mitral valve replacement 479 cases,aortic valve replacement 72 cases, multi -valve replacement 84 cases.Associated Cardiovascular procedures included coronary artery bypass graft in 1 patient and the others in 15 patients. There were 719 prosthetic heart valves implanted. Results Total operative mortality was 9.10%(before 1997 the mortality was 14.5%, after 1997 it descended to 4.1%).The main causes of operative death were low cardiac output syndrome, arrhythmia and renal function failure. Conclusion The better result would be achieved with proper peri-operative care and optimized myocardial protection during operation.