中外医学研究
中外醫學研究
중외의학연구
CHINESE AND FOREIGN MEDICAL RESEARCH
2013年
19期
18-19,20
,共3页
俞晓立%张冬成%林清文%于涛%秦显雨
俞曉立%張鼕成%林清文%于濤%秦顯雨
유효립%장동성%림청문%우도%진현우
心脏瓣膜病%外科治疗%二尖瓣替换%主动脉瓣替换%三尖瓣成形
心髒瓣膜病%外科治療%二尖瓣替換%主動脈瓣替換%三尖瓣成形
심장판막병%외과치료%이첨판체환%주동맥판체환%삼첨판성형
Valvular heart disease%Surgical treatment%Mitral valve replace%Aortic valve replacement%Tricuspid valve repair
目的：总结重症心脏瓣膜病外科治疗的经验，探讨提高手术成功率的措施。方法：回顾性分析1998年8月-2012年12月笔者所在医院收治的106例重症心脏瓣膜病患者的临床资料。其中男41例，女65例，年龄29~73岁，平均(41.2±15.6)岁。心功能Ⅲ级64例，Ⅳ级42例。二尖瓣替换35例，二尖瓣成形手术1例，主动脉瓣替换15例，双瓣替换55例，同期行三尖瓣成形41例和冠脉搭桥18例。结果：手术后早期死亡6例，死亡率为5.7%(6/106)。死亡原因：低心排综合征2例，心室纤颤1例，多脏器功能衰竭2例，脑梗死1例。100例出院患者中，随访89例，随访时间1个月~12年，死亡6例，死亡率6.7%(6/89)，心功能Ⅰ级48例，Ⅱ级36例，Ⅲ级5例。结论：重症心脏瓣膜病的外科治疗应强调矫治二尖瓣和主动脉瓣病变，尽可能保留二尖瓣瓣下结构，积极治疗三尖瓣病变，选择合适的人工瓣膜。同时，还应加强围手术期处理，选择好手术时机，术前注重改善心功能，加强营养支持，这样就能改善重症心脏瓣膜病的治疗效果、降低手术死亡率。
目的：總結重癥心髒瓣膜病外科治療的經驗，探討提高手術成功率的措施。方法：迴顧性分析1998年8月-2012年12月筆者所在醫院收治的106例重癥心髒瓣膜病患者的臨床資料。其中男41例，女65例，年齡29~73歲，平均(41.2±15.6)歲。心功能Ⅲ級64例，Ⅳ級42例。二尖瓣替換35例，二尖瓣成形手術1例，主動脈瓣替換15例，雙瓣替換55例，同期行三尖瓣成形41例和冠脈搭橋18例。結果：手術後早期死亡6例，死亡率為5.7%(6/106)。死亡原因：低心排綜閤徵2例，心室纖顫1例，多髒器功能衰竭2例，腦梗死1例。100例齣院患者中，隨訪89例，隨訪時間1箇月~12年，死亡6例，死亡率6.7%(6/89)，心功能Ⅰ級48例，Ⅱ級36例，Ⅲ級5例。結論：重癥心髒瓣膜病的外科治療應彊調矯治二尖瓣和主動脈瓣病變，儘可能保留二尖瓣瓣下結構，積極治療三尖瓣病變，選擇閤適的人工瓣膜。同時，還應加彊圍手術期處理，選擇好手術時機，術前註重改善心功能，加彊營養支持，這樣就能改善重癥心髒瓣膜病的治療效果、降低手術死亡率。
목적：총결중증심장판막병외과치료적경험，탐토제고수술성공솔적조시。방법：회고성분석1998년8월-2012년12월필자소재의원수치적106례중증심장판막병환자적림상자료。기중남41례，녀65례，년령29~73세，평균(41.2±15.6)세。심공능Ⅲ급64례，Ⅳ급42례。이첨판체환35례，이첨판성형수술1례，주동맥판체환15례，쌍판체환55례，동기행삼첨판성형41례화관맥탑교18례。결과：수술후조기사망6례，사망솔위5.7%(6/106)。사망원인：저심배종합정2례，심실섬전1례，다장기공능쇠갈2례，뇌경사1례。100례출원환자중，수방89례，수방시간1개월~12년，사망6례，사망솔6.7%(6/89)，심공능Ⅰ급48례，Ⅱ급36례，Ⅲ급5례。결론：중증심장판막병적외과치료응강조교치이첨판화주동맥판병변，진가능보류이첨판판하결구，적겁치료삼첨판병변，선택합괄적인공판막。동시，환응가강위수술기처리，선택호수술시궤，술전주중개선심공능，가강영양지지，저양취능개선중증심장판막병적치료효과、강저수술사망솔。
Objective:To summarize the experiences of surgical treatment of severe valvular heart disease and discuss the methods of how to improve the operative success.Methods:106 patients with severe valvular heart disease received surgical treatment from October 1998 to January 2013.There were 41 males and 65 females,aged from 29 to 73 years,the average age was (41.2±15.6)years.Heart function(New York Heart Association Functional Classification) were classⅢ in 64 cases and class Ⅳ in 42 cases pre-operation.Mitral valve replacement was performed in 35 cases.Mitral valve repair in 1 case.Aortic valve replacement in 15 cases.Double valves replacement in 55 cases.Concomitantly,tricuspid valve repaire and coronary artery bypass grafting were applied in 41 and 18 cases respectively.Results:6 cases died early after operation(mortality rate 5.7%).Death causes include 2 cases of low cardiac output syndrome,1 case of ventricular arrhythmia,2 cases of multiple system organ failure and 1 case of cerebral infarct. 89 cases among 100 cases were followed up ranged from 1 month to 12 years, and among them,6 cases died(fatality rate 6.7%),48 cases were restored to heart function class Ⅰ,36 cases to class Ⅱ,and 5 cases to class Ⅲ .Conclusion:Surgical treatment of severe valvular heart disease should focus on correcting pathological changes of mitral valve and aortic valve,reserving the mitral subvalvular structure as much as possible,treating disordered tricuspid valve and selecting appropriate artificial valves.Meanwhile,we should focus on selecting appropriately operative timing,improving pre-surgical heart function and enhancing nutrition.These measures can be expected to improve the surgical outcomes of severe valvular heart disease and lower operative mortality.
