上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (6): 836-.doi: 10.3969/j.issn.1674-8115.2011.06.035

• 论著（临床研究） • 上一篇    下一篇

375例大左室心脏瓣膜病患者外科治疗的临床分析

叶一舟, 沈 锋, 董莉亚, 袁忠祥   

  1. 上海交通大学 第一人民医院心血管外科, 上海 200080
  • 出版日期:2011-06-28 发布日期:2011-06-27
  • 通讯作者: 袁忠祥, 电子信箱: sf02048207@163.com。
  • 作者简介:叶一舟(1970—), 男, 副主任医师, 硕士；电子信箱: yeyizhouvip@sina.com。

Surgical treatment of 375 cases of valvular heart disease with large left ventricle

YE Yi-zhou, SHEN Feng, DONG Li-ya, YUAN Zhong-xiang   

  1. Department of Cardiovascular Surgery, the First People's Hospital, Shanghai Jiaotong University, Shanghai 200080, China
  • Online:2011-06-28 Published:2011-06-27

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摘要：

目的 回顾性总结大左室心脏瓣膜病的外科治疗经验。方法 收集375例大左室心脏瓣膜病患者的临床资料。所有患者均在全身麻醉低温体外循环下接受手术治疗，其中二尖瓣置换术88例，主动脉瓣置换术206例，二尖瓣置换术+主动脉瓣置换术81 例；225例患者同时接受三尖瓣成形术。对术后早期并发症和死亡发生情况、死亡原因及随访资料进行回顾性分析。结合文献总结外科治疗经验。结果 375例患者发生术后早期并发症97例次（25.87%），其中室性心律失常46例（12.27%），肾功能不全18例（4.80%），肺部感染17例（4.53%），低心排综合征12例（3.20％），因出血再次开胸4例（1.07%）。术后早期死亡12例（3.20%），死亡原因分别为术后早期并发低心排综合征4例，室性心律失常和肾功能不全各3例，肺部感染2例；其余患者均治愈出院。随访期内（2~12个月）无死亡病例，患者心功能明显改善。结论 术前准备完善、术中操作精确迅捷、心肌保护充分及术后严格的监护室治疗等是大左室心脏瓣膜病患者外科治疗成功的关键。

关键词: 瓣膜置换术, 心脏瓣膜病, 大左室, 外科治疗, 并发症

Abstract:

Objective To retrospectively summarize the experience of surgical treatment of valvular heart disease with large left ventricle. Methods The clinical data of 375 cases of valvular heart disease with large left ventricle were collected. All cases were performed operations under general anesthesia with hypothermic cardiopulmonary bypass, including mitral valve replacement in 88 cases, aortic valve replacement in 206 cases and combined mitral and aortic valve replacement in 81 cases. Two hundred and twentyfive cases received tricuspid valvoplasty at the same time. The early postoperative complications, early mortality rate, causes of death and follow-up data were retrospectively analysed. The experience of surgical treatment was summarized on the basis of literature review. Results The early postoperative complications occurred in 97 cases (25.87%), including low cardiac output syndrome (12 cases,3.20％), lung infection (17 cases,4.53%), renal insufficiency (18 cases, 4.80%), ventricular arrhythmia (46 cases,12.27%) and a second operation due to postoperative hemorrhage (4 cases,1.07%). The early mortality rate was 3.20% (12 cases), and the death causes were low cardiac output syndrome (4 cases), ventricular arrhythmia (3 cases), renal insufficiency (3 cases) and lung infection (2 cases). All the other cases were cured and discharged. There was no death during the follow-up (2 months to 1 year), and the cardiac function of these cases was significantly improved. Conclusion The comprehensive preoperative preparation, precise operative procedure, sufficient myocardial preservation and proper management in intensive care unit were the keys to the successful surgical treatment of valvular heart disease with large left ventricle.

Key words: valve replacement, valvular heart disease, large left ventricular, surgical treatment, complication