摘要
目的总结心脏瓣膜病患者瓣膜置换术的临床经验。方法回顾性分析2005年3月至2012年9月1435例心脏瓣膜置换术患者的临床资料，风湿性心脏病1219例，其他原因216例；NYHA心功能分级：Ⅰ级58例，Ⅱ级322例，Ⅲ级993例，Ⅳ级62例；手术二尖瓣置换867例，主动脉瓣置换253例，二尖瓣联合主动脉瓣置换315例，三尖瓣置换2例，同时三尖瓣成形329例，冠状动脉旁路移植28例，左房血栓清除63例。合并其他手术14例。结果本研究手术早期死亡24例（1．67％），以低心排综合征和心律失常最常见，占死亡原因的50％。手术早期并发症：各种心律失常142例，肺部并发症53例，低心排综合征43例，水电解质紊乱等。晚期并发症以慢性充血性心力衰竭和心律失常为主。结论心脏瓣膜置换术是治疗心脏瓣膜病的有效方法。充分的术前准备、合适的手术时机、良好熟练的手术技术、手术理念、及时准确的围术期处理是降低并发症提高疗效最重要的措施。术后积极预防和治疗慢性心衰、适度的抗凝是保证患者远期生存的重要因素。
Objective To summarize the clinic experience of patients with heart valve disease underwent cardiac valve replacement. Methods The clinic data of 1435 patients underwent cardiac valve replacement from March 2005 to September 2012 were retrospectively analyzed. Among them, there were 1219 cases of rheumatic heart disease, 216 cases of other etiological factor. According to New York Heart Association, 58 cases were in heart function first class, 322 cases were in second class, 993 cases were in third class, 62 cases were in fourth class. Respectively, there were 867 cases of mitral valve re- placement, 253 cases of aortic valve replacement, 315 cases of mitral valve combining aortic valve re- placement, 2 cases of tricuspid valve replacement. Simultaneously, there were 329 caes of tricuspid valve shaping, 28 cases of coronary artery bypass grafting, 63 cases of left atrial thrombectomy, 14 cases com- plicating other operation. Results There were 24 cases （ 1.67% ） of earlier death, the cause of death was mainly low heart output syndrome and cardiac dysrhythmia, accounting for 50%. Earlier operation complications including 142 cases of various cardiac dysrhythmia, 53 cases of lung complication, 43 ea- ses of low heart output syndrome and water-electrolyte disturbances. Later complication mainly including chronic congestive heart failure and cardiac dysrhythmia. Conclusions Cardiac valve replacement is a good method to cure valvular disease of the heart. Sufficiently preoperative preparation, suitable operation opportunity, perfectly surgical technic and surgical idea, timely and precisely perioperative disposal all are capital measurement to reduce complication and improve curative effect. After operation, positively prevent and cure chronic heart failure, moderate antieoagulation are important factors to guarantee pa- tients long-term survival.
出处
《中国实用医刊》
2013年第15期9-11,共3页
Chinese Journal of Practical Medicine
关键词
心脏瓣膜疾病
人工心脏瓣膜
心脏外科手术
Heart valve disease
Heart valve prosthesis
Cardiac surgery operation
