CAJ | 학술논문

目的：总结浅低温心脏不停跳技术在重症心脏瓣膜病患者瓣膜替换手术中应用临床体会。方法132例重症心脏瓣膜病患者在浅低温体外循环心脏不停跳下行人工瓣膜替换术。其中二尖瓣替换78例，主动脉瓣替换34例，双瓣膜替换18例，三瓣膜替换2例。所有病例中需要同期行CABG12例。结果全组手术死亡2例，死亡率为1.5%。并发症包括：低心排综合症4例，应用IABP辅助2例，死亡1例。急性肾功能衰竭1例，经肾替代治疗无好转后死亡。肺部感染5例，经抗炎治疗后痊愈。手术切口感染7例，经加强换药治疗后痊愈。无气栓发生，无呼吸衰竭及消化道出血。血红蛋白尿23例，发生率17%，经碱化尿液治疗后痊愈。结论浅低温心脏不停跳下行瓣膜替换有较好的心肌及其他重要脏器保护作用，能减少病死率及并发症的发生，尤其适应于重症瓣膜病患者。
목적：총결천저온심장불정도기술재중증심장판막병환자판막체환수술중응용림상체회。방법132례중증심장판막병환자재천저온체외순배심장불정도하행인공판막체환술。기중이첨판체환78례，주동맥판체환34례，쌍판막체환18례，삼판막체환2례。소유병례중수요동기행CABG12례。결과전조수술사망2례，사망솔위1.5%。병발증포괄：저심배종합증4례，응용IABP보조2례，사망1례。급성신공능쇠갈1례，경신체대치료무호전후사망。폐부감염5례，경항염치료후전유。수술절구감염7례，경가강환약치료후전유。무기전발생，무호흡쇠갈급소화도출혈。혈홍단백뇨23례，발생솔17%，경감화뇨액치료후전유。결론천저온심장불정도하행판막체환유교호적심기급기타중요장기보호작용，능감소병사솔급병발증적발생，우기괄응우중증판막병환자。
Objective: To summarize the clinical experience of cardiac valve replacement in serious patients by beating heart CPB (cardiac pulmonary bypass) on light hypothermia. Method:Valve replacements were performed in 132 serious cardiac valvular cases by beating heart CPB on light hypothermia from August 2000 to January 2014.Mitral valve replacement 78 cases,Aortic valve replacement 34 cases,Double valves replacement 18 cases,Three vavles replacement 3 cases and coronary artery bypass grafting in 12cases. Result:The early death was 2 cases,the mortality was 1.5%. Low cardiac output was 4 cases,2 cases were assistanted by IABP and 1 cases was dead.Acute renal failure was 1cases who was dead after treated by CRRT. Pneumonia was 5 cases and healed by antibiotics therapy. Surgicl site infection was 7 cases and healed by changed dressings therapy.Non air embolism、respiratory failure and alimentary tract hemorrhage happened. Hemoglobinuria was 23 cases(17%) and healed by alkalized urine therapy. Conclusion:Valve replacement by beating heart CPB on linght hypothermia could proect myocardium and other organs efficiently,could reduse mortality and complication significantly.This technology adapt to serious patients with vale dieases especial y.