摘要
目的:探讨巨大左心室患者心脏瓣膜手术围术期的病情及其处理特点。方法:回顾性分析1990年1月至1998年12月129例巨大左心室(收缩期末直径5.04～8.14cm)患者心脏瓣膜手术的临床资料,其中行二尖瓣置换或成形术(MVRP)31例、主动脉瓣置换术(AVR)34例、二尖瓣与主动脉瓣双瓣置换术(DVR)64例。结果:患者以中青年男性为主(83.72%);瓣膜病变以关闭不全为主;病因主要为风湿性(47.28%)、退行性变(27.13%)和心内膜炎(13.17%);手术早期并发症总发生率为41.08%,DVR组显著高于MVRP组(P<0.05);术后早期总死亡率为11.63%,3组间无统计学差异(P>0.05)。结论:选择合适的手术时机,围术期加强心肺功能支持,注意室性心律失常和多器官功能衰竭的防治,是提高这类巨大心室患者心脏瓣膜手术早期疗效的关键。
Objective: To analyze the clinical characteristics and perioperative management of patients with giant left ventricle (GLV) undergoing heart valve surgery. Methods: The clinical materials of 129 GLV patients received heart valve surgery between Jan. 1990 and Dec.1998 were analyzed retrospectively. The preoperative left ventricular end systolic diameters ranged from 5.04～8.14 cm with a mean of 5.91±0.62 cm. Mitral valve replacement or valvuloplasty (MVRP) was performed in 31 cases, aortic valve replacement (AVR) in 34 and double valve replacement (DVR) in 64. Results: Patients were predominantly young and middle aged adult male patients (83.72%). The main pathology of the valve lesions was severe valve insufficiency and the common causes of the valve lesions were rheumatic (47.28%), degenerative (27.13%) and endocarditis (13.17%). The early postoperative complication rate was 41.08%, which was higher in DVR group than that in MVRP group ( P <0.05). The mortality rate was 11.63%, which was higher in DVR group than that in AVR and MVRP groups but with no statistical significance( P >0.05). Conclusion: The keypoint to improve the early surgical result are the choice of optimal surgical timing, the supporting of heart and lung function, the prevention and treatment of ventricular arrhythmia and multiple organ failure during perioperative period.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
1999年第12期1018-1020,共3页
Academic Journal of Second Military Medical University
基金
全军"九五"医药卫生科研基金!项目编号96 Z0 3 1
关键词
巨大左心室
心脏瓣膜手术
围手术期
giant ventricle, left
heart valve surgery
intraoperative management
