中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
1期
82-85
,共4页
罗又桥%方海宁%谭伟%李树松%曹辉庆%赖纪昌
囉又橋%方海寧%譚偉%李樹鬆%曹輝慶%賴紀昌
라우교%방해저%담위%리수송%조휘경%뢰기창
风湿性心脏病%心瓣膜置换术后%三尖瓣返流%外科治疗
風濕性心髒病%心瓣膜置換術後%三尖瓣返流%外科治療
풍습성심장병%심판막치환술후%삼첨판반류%외과치료
Rheumatic heart disease%Heart valve replacement%Tricuspid regurgitation%Surgical treatment
目的 分析风湿性心脏病二尖瓣置换术后再发三尖瓣返流(TR)患者的临床特点、外科手术方法和疗效,总结围手术期处理经验.方法 2000年1月至2011年12月,17例风湿性心脏病二尖瓣置换术后再发三尖瓣返流的患者在我院接受单纯再次三尖瓣手术,行三尖瓣成形术10例,包括单纯DeVega成形术1例、瓣叶成形+人工瓣环成形9例;行三尖瓣置换术7例,其中置换生物瓣4例,双叶机械瓣3例,回顾性分析其临床表现、诊治经过和预后情况.结果 术后早期死亡1例(5.88%,1/17),死于术后左心功能衰竭.术后发生低心排血量综合征3例,肾功能不全2例,呼吸功能不全2例,均成功救治.随访14例,随访时间3~9年,心功能Ⅰ级2例,Ⅱ级8例,Ⅲ级4例.失访2例.结论 对风湿性心脏病二尖瓣置换术后三尖瓣返流患者再手术治疗效果较好,合理掌握手术指征、手术时机和良好的围手术期处理是提高手术成功率的关键.
目的 分析風濕性心髒病二尖瓣置換術後再髮三尖瓣返流(TR)患者的臨床特點、外科手術方法和療效,總結圍手術期處理經驗.方法 2000年1月至2011年12月,17例風濕性心髒病二尖瓣置換術後再髮三尖瓣返流的患者在我院接受單純再次三尖瓣手術,行三尖瓣成形術10例,包括單純DeVega成形術1例、瓣葉成形+人工瓣環成形9例;行三尖瓣置換術7例,其中置換生物瓣4例,雙葉機械瓣3例,迴顧性分析其臨床錶現、診治經過和預後情況.結果 術後早期死亡1例(5.88%,1/17),死于術後左心功能衰竭.術後髮生低心排血量綜閤徵3例,腎功能不全2例,呼吸功能不全2例,均成功救治.隨訪14例,隨訪時間3~9年,心功能Ⅰ級2例,Ⅱ級8例,Ⅲ級4例.失訪2例.結論 對風濕性心髒病二尖瓣置換術後三尖瓣返流患者再手術治療效果較好,閤理掌握手術指徵、手術時機和良好的圍手術期處理是提高手術成功率的關鍵.
목적 분석풍습성심장병이첨판치환술후재발삼첨판반류(TR)환자적림상특점、외과수술방법화료효,총결위수술기처리경험.방법 2000년1월지2011년12월,17례풍습성심장병이첨판치환술후재발삼첨판반류적환자재아원접수단순재차삼첨판수술,행삼첨판성형술10례,포괄단순DeVega성형술1례、판협성형+인공판배성형9례;행삼첨판치환술7례,기중치환생물판4례,쌍협궤계판3례,회고성분석기림상표현、진치경과화예후정황.결과 술후조기사망1례(5.88%,1/17),사우술후좌심공능쇠갈.술후발생저심배혈량종합정3례,신공능불전2례,호흡공능불전2례,균성공구치.수방14례,수방시간3~9년,심공능Ⅰ급2례,Ⅱ급8례,Ⅲ급4례.실방2례.결론 대풍습성심장병이첨판치환술후삼첨판반류환자재수술치료효과교호,합리장악수술지정、수술시궤화량호적위수술기처리시제고수술성공솔적관건.
Objective To analyze clinical manifestation and investigate therapy effect of re-operation of tricuspid regurgitation (TR) after mitral valve replacement with rheumatic heart disease.Methods Seventeen cases with rheumatic heart disease recurred TR after mitral valve replacement surgery,underwent tricuspid valve surgery again in the Third People's Hospital of Nanchang from January 2000 to December 2011.Of 17 cases,10cases underwent tricuspid valve annuloplasty including 1 case for pure De Vega plasty,9 cases for the valve leaflets forming + artificial valve ring forming.Another 7 cases underwent tricuspid valve replacement surgery including 4 cases for biological valve replacement and 3 cases for mechanical valve.Retrospective analyzed the clinical manifestations,treatment process and condition of prognosis.Results One case was with early postoperative deaths (5.88%,1717),and died of postoperative left ventricular failure.Three cases were postoperative low cardiac output syndrome,2 cases were renal insufficiency,and 2 cases were respiratory insufficiency,all those cases were successfully cured.Sixteen cases were followed up from 3 months to 9 years and 2 cases were lost.Of 14,2 cases were NYHA class Ⅰ,8 cases for grade Ⅱ,4 cases for grade Ⅲ.Conclusion After mitral valve replacement in patients with rheumatic heart disease,TR in patients with reoperation is a suitable choice.Reasonable surgical indications,timing of surgery and good perioperative management are the keys to improve the success rate of surgery.