心脏瓣膜术后顽固性右心衰竭临床治疗分析

Analysis on the clinical treatment of refractory right heart failure after cardiac valve operation

目的探讨总结心脏瓣膜术后顽固性右心衰竭临床治疗经验。方法回顾性分析2015年10月—2018年9月在本院心脏外科行心脏瓣膜术后并发顽固性右心衰竭的30例患者的临床资料,统计其术前准备、手术方式、体外循环时间、术后并发症、术后个体化治疗等临床资料。结果本院心脏瓣膜术后符合顽固性右心衰竭纳入标准的患者共30例,体外循环转流时间(131.4±21) min(99~193 min),主动脉阻断时间(75.4±16.5) min(56~158 min)。30例患者其中3例并发肺部感染最终死于感染性休克;8例行CRRT治疗,3例患者并发肾功能衰竭,均死亡;2例患者术后右心衰竭后出现多器官功能障碍;其中2例手术当日行二次开胸止血,切口感染1例,并发急性胆囊炎1例,4例患者出现消化道出血。本组患者死亡8例,余22例患者术后30~55天好转出院。结论多方面的右心功能的动态评估及早期的药物治疗和体外机械辅助等联合治疗能够使心脏瓣膜术后顽固性右心衰竭患者取得良好的预后。

Objective To summarize the clinical treatment experience of refractory right heart failure after cardiac valve operation.Methods Retrospective analysis was performed on the clinical data of 30 patients with intractable right heart failure after cardiac valve operation in the first affiliated hospital of Bengbu Medical college from October 2015 to September 2018.The clinical data of preoperative preparation,surgical method,extracorporeal circulation time,postoperative complications and postoperative individualized treatment were collected.Results Thirty patients who met the inclusion criteria of refractory right heart failure after cardiac valve operation in our hospital were treated with extracorporeal circulation(131.4±21)min(99~193 min),and aortic occlusion(75.4±16.5)min(56~158 min).Three of the 30 patients were complicated by pulmonary infection and died of septic shock.8 patients were treated with CRRT,and 3 patients died of renal failure.Two patients had multiple organ dysfunctions after right heart failure.Two of the patients received secondary thoracotomy for hemostasis on the day of operation,and one had incision infection,one had acute cholecystitis,and four had gastrointestinal hemorrhage.In this group,8 patients died,and the remaining 22 patients were discharged after30~55 days.Conclusions Multiple dynamic evaluations of right heart function and early drug therapy combined with extracorporeal mechanical assistance could make patients with refractory right heart failure achieve a good prognosis after valvular surgery.