83例重症心脏瓣膜病的外科治疗体会.docx

83例重症心脏瓣膜病的外科治疗体会【摘要】目的总结重症心脏瓣膜病的手术治疗经验。方法2004年6月至2011年6月我院共对82例重症心脏瓣膜病患者实行了心脏瓣膜置换术。结果术后早期死亡4例3例死于术后低心输出量综合征1例于术后一周出现心包填塞呼吸、循环功能衰竭抢救无效死亡余病例全部康复出院。死亡率4.82%。术后随访复查心脏彩超示心脏均有不同程度缩小心功能均有改善其中心功能Ⅰ级20例Ⅱ级56例Ⅲ级4例。结论只要严格掌握手术适应证积极有效的术前准备加强心肌保护和提高手术技巧严密的术后监护就可以提高重症心脏瓣膜病手术的成功率。【关键词】心脏瓣膜病；外科治疗83casesofseveresurgicaltreatmentofvalvularheartdiseaseLIXiang-qunCHENGui-heJIANGZhao-yangetal.HuaihuaFirstPeoplesHospitalHuaihua418000China【Abstract】ObjectiveTosummarizethesurgeryexperienceofseverevalvularheartdisease.MethodsFromJune2004toJune2011atotalof82patientsinourhospitalwithsevereheartvalvediseaseunderwentvalvereplacementsurgery.ResultsEarlypostoperative4died3diedoflowcardiacoutputsyndrome1casediedofrespiratorycirculatoryfailureinaweekaftersurgerybecauseofpericardialtamponade.Theremainingpatientsallrecoveredandweredischarged.Mortalityratewas4.82%.Follow-upof74casesallreviewedofechocardiography20casesofshowedvaryingdegreesofreducedcardiaccardiacfunctionwereimprovedthecenterfeatures20casesofcardiacfunctiongradeⅠ56casesingradeⅡ4casesingradeⅢ.ConclusionItcouldincreasetheachievementratiointheoperationswithseverevalvularheartdiseasebyStrictindicationseffectivepreoperativepreparationandmyocardialprotectionskilledsurgicaltechniquesandclosemonitoring.【Keywords】Valvularheartdisease；Surgicaltreatment重症心脏瓣膜病患者由于病程长瓣膜病变重心肌损伤重心功能差很多合并有多脏器功能损害手术风险大术后并发症多死亡率高。2004年6月~2011年6月笔者所在院对83例重症心脏瓣膜病患者实行了心脏瓣膜置换术由于提高了手术技术重视围手术期各个环节的处理采取综合措施取得良好效果现总结报告如下。1资料和方法1.1一般资料本组患者男33例女50例年龄17~61岁平均（41.4±4.29）岁病程1.5~25年术前均行心脏彩超、胸片、心电图和冠脉造影检查（50岁以上）等明确诊断。其中风湿性心脏病69例退行性心脏瓣膜病11例先天性心脏病3例。单纯主动脉瓣病变10例单纯二尖瓣病变12例主动脉瓣和二尖瓣联合瓣膜病变60例。三尖瓣中重度关闭不全25例巨大左房16例肺动脉高压10例左房血栓12例。合并高血压6例糖尿病4例脑梗塞5例胆囊炎1例肾功能不全3例。心功能Ⅱ~Ⅲ级60例心功能Ⅳ级22例心电图示房颤65例胸片示心胸比率为0.55-0.91心脏彩超示左心室舒张末期内径（LVEDD）54~93mm左心室收缩末期内径（LVESD）40~69mm左室射血分数（EF）为32%~61%。1.2手术