风湿性与先天性心脏病术后心影大小变化的分析

Postoperative changes of cardiac size in the patients with rheumatic cardiac valve disease and congenital heart disease

目的分析风湿性心脏瓣膜病(风心病)及先天性心脏病(先心病)术后心影的大小变化及相关因素。方法32例风心病及45例先心病均在术前、后半月～11个月内数次行X线心脏远达片及超声心动图检查。结果术后半月～1个月首次X线复查风心病患者心影缩小者占62.5%,2次复查心影缩小者占81.2%,手术死亡率3.12%,发生早期并发症的患者占56.2%。先心病术后首次复查心影缩小者26.6%,2次复查占68.8%,手术死亡率6.6%,发生早期并发症42.3%。结论风心病及先心病患者术后11个月内复查大部分患者效果良好,心功能有显著改善,前者心脏缩小较后者明显,术后30d内死亡率较后者低。两者少部分患者疗效差的原因主要考虑术前病史长、心功能差、多发性畸形、术后早期并发症的影响及风湿活动、服药不规律等因素。

Objective To study the postoperative changes of cardiac size in the patients with rheumatic cardiac valve disease(RCVD) and congenital heart disease (CHD) and to discuss the relative factors.Methods Thirty- two patients with RCVD underwent valve replacements and forty- five patients with CHD underwent heart operation in our hospital.All patients underwent cardioroentgenogram and echocardiogram at a half of month～ 11 months before and after the operation.Results 62.5 % of the patients with RCVD in cardiac shadow was shrunken at postoperative 1 month,which was 81.2 % of patients during postoperative 2～ 11months.Total operative mortality was 6.6 % .42.3 % of the patients had postoperative complications.At 11 month after the operation,shrank of heart shadow in most patients with RCVD and CHD was evident,simultaneously,heart function was improved.Operatiove effect of the former was more satisfactory than that of the later.The worse effect was found in partial patients,which was considered as due to longer medical history,worse cardiac function,preoperative multiple malformation,postoperative early complications,rheumatic activity,and the drugs were not taken on time after operation,etc. [