系统性红斑狼疮瓣膜性心脏病外科治疗的系统分析

目的通过对国外有关系统性红斑狼疮(SLE)瓣膜性心脏病外科治疗的文献进行系统分析,探讨其外科治疗方法。方法检索1979年~2004年中国学术期刊全文数据库(CNKI)、1994年~2004年中文生物医学期刊文献数据库(CMCC)、1966年~2004年Pubmed数据库中有关SLE心脏瓣膜病外科治疗的文献并进行系统分析。结果国内数据库中未检索到相关文献,Pubmed数据库中检索到相关文献57篇,共计81例。资料显示瓣膜病变累及二尖瓣58例,累及主动脉瓣32例,同时累及到上述两个瓣膜共11例,单纯累及三尖瓣1例。大多数病例术前使用过类固醇治疗,术前心功能为3或4级。外科治疗方法包括机械瓣膜置换术(29例)、生物瓣膜置换术(19例)、瓣膜成形术(10例)、同种组织瓣膜置换术(2例)。生物瓣膜置换术后发生瓣膜穿孔2例、瓣周漏2例;瓣膜成形术后再手术5例。术后患者心功能恢复良好,30 d死亡率9.9%。结论SLE病变瓣膜主要为二尖瓣和主动脉瓣,多表现为单一瓣膜,类固醇治疗可能引起SLE心脏瓣膜损害。因瓣膜损害而使血液动力学显著改变时可进行手术治疗,手术较为安全,术后效果良好。手术方式主要为瓣膜置换和成形术。瓣膜成形术后易再发瓣膜炎,生物瓣膜置换术后可再发瓣膜炎致瓣膜穿孔、瓣周漏而需要再次手术。机械瓣膜置换术对于SLE瓣膜性心脏病患者更为合适。

Systematic analysis of surgical treatment of valvular heart disease in systemic lupus erythematosus

Objective To probe surgical treatment for valvular heart disease in systemic lupus erythematousus(SLE) through analysis of the previous literatures.Methods Retrieving the literatures related to surgical treatment of valvular heart disease in SLE including CNKI(1979-2004),CMCC(1994-2004), Pubmed(1996-2004).Results No literature reported in CNKI and CMCC databases.The related literatures reported pubmed databases were 57 papars(and 81 patients).Majority of the patients had been treated with steroid prior to operation with a heart function class ed 3.or 4.All patients had heart failure of NYHA.Surgical treatments include mechanical valve replacement(29 cases),biovalve replacement(19 cases),valve plasty or repair(10 cases),homograft replacement(2 cases).There were valve perforation in 2 cases and pervavlvular leak in 2 case with post-operatic complications of biovalve replacement.The re-operation was 5 patients in 10 patients receiving valve plasty or repair.Postoperative heart function was fine with a death rate of 9.9% within 30 d after operation.Conclusion The mitral and aortic valve are the most predominant lesions in SLE,which is often single valve lesion.And steroid treatment may injure the heart valve.Operative modus mainly includes valve replacement and valve plasty or repair.Recurrent valvulitis and valve dysfunction in repaired or biovalve replacement need re-operation.Mechanical valve replacement is more suitable than bioprosthetic valve replacement and valve plasty or repair for SLE.