摘要
目的：总结10例人工心脏生物瓣膜再次置换手术的原因、并发症及疗效。方法自2014年1月至2015年11月，10例人工心脏生物瓣膜换瓣患者再次接受人工瓣膜置换手术。手术均在体外循环心脏不停跳下进行，手术均再次行正中切口。采用冷血高钾心脏停搏液，辅以全身低体温〈30℃。行升主动脉，上、下腔静脉插管建立体外循环，术中备股动静脉插管。结果住院期间1例行二次开胸止血，术中探查未发现明显活动性出血，但心包粘连面广泛渗血。予电凝刀创面广泛止血，术后予氨甲环酸、血凝酶、冷沉淀、血小板加强止血治疗，二次手术后引流明显减少。无死亡病例。术后其他并发症：肺炎肺不张1例，胸腔积液1例，心包积液1例，慢性肾功能不全1例，经积极治疗后痊愈。住院天数25~50d。出院时心功能改善至Ⅰ级6例，Ⅱ级4例。结论随着心脏瓣膜置换术的广泛开展，人工生物瓣膜置换术后瓣膜功能障碍情况增多，其诊治是心脏外科面临的重要课题。再次行瓣膜置换应掌握手术时机，手术难度大、风险大，术前需调整好患者的心肺功能及营养状态，术中快速细致轻柔操作，加强心肌保护治疗，掌握确切的手术方式，手术疗效确切，可有效改善患者的预后。
ObjectiveTo summarize the causes,complications and curative effect of 10 cases of cardiac biological valve replacement surgery. MethodsFrom January 2014 to November 2015,10 cases of cardiac biological valve patients in our department accepted the replacement of atificial valve surgery again. All performed were under cardiopulmonary bypass on arresting heart,reoperation were again from midline incision. The cold high potassium cardiac arrest liquid was used,supplemented by general mild low temperature below 30℃. Extracorporeal circulation was established for the ascending aorta,the superior and the inferior vena cava intubation,prepared for femoral arteriovenous intubation.Results One secondary hemostatic operation occurred in 1 case,intraoperative probe found no obvious active bleeding,but pericardial adhesion surface oozed blood. With electric coagulation knife wound bleeding,postoperative to tranexamic acid,blood clotting enzyme,cryoprecipitate,platelet strengthen hemostatic treatment,drainage decreased significantly after the second surgery. No deaths. Postoperative complications are：pneumonia atelectasis in 1 case, pleural effusion in 1 case,pericardial effusion in 1 case,chronic renal insufficiency in 1 case,recovered after active treatment. Hospitalization days were from 25 and 50. The cardiac function of 6 cases improved to grade I,4 cases improved to gradeⅡ.Conclusion As the cardiac valve replacement were extensively developed,and the artificial biological valve dysfunction after valve replacement were increasingly seen more,its diagnosis and treatment are important tasks to cardiac surgery. Second valve replacement should grasp the operation time.The operation difficulty and risk are big,making it necessary to adjust to good preoperative cardiopulmonary function and nutritional status of patients,and intraoperative rapid meticulous and gentle operation manuevour,to strengthen the myocardial protection treatment.As long as the right case is selected and expertized operation technique is mastered,,a
出处
《浙江临床医学》
2016年第10期1815-1816,共2页
Zhejiang Clinical Medical Journal
