心脏二次手术疗效分析

Effectiveness Analysis on Reoperation on Patients with Heart Diseases

目的 探讨心脏二次手术的经验及围术期处理要点。方法 1998年 1月至 2 0 0 2年 7月 ,我院对 2 7例心脏病患者行第二次手术治疗。第一次手术类型 :二尖瓣闭式扩张术 2 0例 ,二尖瓣球囊扩张术 2例 ,二尖瓣生物瓣置换术 2例 ,左心房黏液瘤摘除术 2例 ,室间隔缺损修补术 1例。第一、二次手术间隔时间 2～ 18(平均 10± 7)年。二次手术方式为 :单纯二尖瓣置换术 2 0例 ,二尖瓣并主动脉瓣置换术 4例 ,部分房间隔切除并黏液瘤摘除术 2例 ,室缺残余漏直接修补 1例。结果 术后二次开胸止血 3例 ,住院死亡 6例 ,其余病例均康复出院。结论 心脏二次手术术前应充分改善病人一般情况 ,术中强调心肌保护及彻底止血 ,术后使用必要的血管活性药物等对于提高疗效均十分重要。

Objective To study the experience of surgical treatment during reoperation on patients with heart diseases.Method 27 patients with heart disease received the second operation from January 1998 to July 2002.The first operations included:mitral commissurotomy in 20 cases,mitral valve commissurotomy by percutaneous balloon catheter in 2 cases,mitral valve replacement with bioprosthetic cardiac valve in 2 cases,myxoma excision in 2 cases,direct remnent prothesis of VSD in 1 case.The duration between two operations was 2～18(10±7) years.The second operations included:mitral valve replacement in 20 cases,mitral valve and aortic valve replacement in 4 cases,partial atrial septal excision and myxoma excision in 2 cases,direct remnent prothesis of VSD in 1 case.Results 3 cases accepted the second thoractomy to hemostasis,6 cases died and others recovered after operation.Conclusions The physical condition of patients should be improved as better as possible before reoperation.Myocardio protection,prevention of bleeding and appropriate use of drug are all important to improving the efficacy.