CAJ | 학술논문

目的观察机械瓣膜置换术后瓣膜故障再次手术换瓣临床效果,分析故障原因、手术时机选择及手术效果.方法选择2003年3月至2010年5月行再次手术换瓣患者33例,其中二尖瓣置换术17例、主动脉瓣置换术9例、二尖瓣+主动脉瓣置换术2例、二尖瓣置换+三尖瓣成形术2例、三尖瓣置换术3例.治疗前后对患者行心功能评级,参照纽约心脏病协会(NYHA)心功能标准,进行比较分析.结果 33例再次手术换瓣患者中,死亡1例(3.0％),32例存活患者心功能明显改善.33例患者术前心功能分级Ⅰ级0例,Ⅱ级13例(39.4％),Ⅲ级15例(45.4％),Ⅳ级5例(15.2％)；术后6个月复查,32例患者存活,心功能分级Ⅰ级16例(50.0％),Ⅱ级12例(37.5％),Ⅲ级4例(12.5％),Ⅳ级0例.术后6个月与术前心脏功能相比,Ⅰ、Ⅲ、Ⅳ级患者比例差异均有统计学意义(均P ＜0.05).Ⅱ级手术前后差异无统计学意义(P＞0.05).结论人工机械瓣膜置换术后瓣膜故障,再次手术置换新瓣是其主要治疗手段,要注意手术时机、手术方法和瓣膜种类的选择.
목적 관찰궤계판막치환술후판막고장재차수술환판림상효과,분석고장원인、수술시궤선택급수술효과.방법 선택2003년3월지2010년5월행재차수술환판환자33례,기중이첨판치환술17례、주동맥판치환술9례、이첨판+주동맥판치환술2례、이첨판치환+삼첨판성형술2례、삼첨판치환술3례.치료전후대환자행심공능평급,삼조뉴약심장병협회(NYHA)심공능표준,진행비교분석.결과 33례재차수술환판환자중,사망1례(3.0％),32례존활환자심공능명현개선.33례환자술전심공능분급Ⅰ급0례,Ⅱ급13례(39.4％),Ⅲ급15례(45.4％),Ⅳ급5례(15.2％)；술후6개월복사,32례환자존활,심공능분급Ⅰ급16례(50.0％),Ⅱ급12례(37.5％),Ⅲ급4례(12.5％),Ⅳ급0례.술후6개월여술전심장공능상비,Ⅰ、Ⅲ、Ⅳ급환자비례차이균유통계학의의(균P ＜0.05).Ⅱ급수술전후차이무통계학의의(P＞0.05).결론 인공궤계판막치환술후판막고장,재차수술치환신판시기주요치료수단,요주의수술시궤、수술방법화판막충류적선택.
Objective To observe the effect of the re-operation after mechanical valve replacement and to analyze dysfunction reason,operation time and operation effect of reoperation.Methods Thirty-three cases with reoperation of valve replacement were chosen from March 2003 to May 2010,including 17 cases of mitral valve replacement,9 aortic valve replacement,2 mitral valve and aortic valve replacement,2 mitral valve replacement and 3 tricuspid valve annuloplasty and 3 tricuspid valve replacement Heart function was compared before and after operation according to the New York Heart Association (NYHA).Results Among 33 cases of reoperation,1 case (3.0％)died and heart function of 32 survival cases improved significantly.The number of preoperative heart function grade Ⅰ,Ⅱ,Ⅲ,Ⅳ was 0,13 (39.4％ ),15 (45.4％)and 5 (15.2％ ).After 6 months,32 patients survived;the number of preoperative heart function grade Ⅰ, Ⅱ,Ⅲ,Ⅳ was 16 (50.0％),12 (37.5％),4 (12.5％ )and 0.The proportion of the patients in grade Ⅰ,Ⅲ,Ⅳ showed statistical difference (P ＜0.05).Conclusion Reoperation is the main therapy method of treating valve dysfunction after mechanical valve replacement;we should pay attention to operation time,operation method and selection of valve type.