合并重度肺动脉高压瓣膜病患者行机械瓣膜置换的围术期治疗

目的总结分析瓣膜病合并重度肺动脉高压患者行机械瓣膜置换术的围术期治疗经验。方法分析瓣膜病合并重度肺动脉高压(肺动脉收缩压>70 mmHg)的机械瓣膜置换术患者41例,其中二尖瓣置换术(MVR)21例(风心病19例,脱垂2例),主动脉瓣置换术(AVR)4例(风心病3例,二叶瓣畸形1例),双瓣置换术(MVR+AVR)16例(均为风心病),同时行De Vega三尖瓣成形术27例,冠状动脉旁路移植术3例,左房血栓清除术6例。回顾术前治疗措施、术中注意事项、术后治疗方法 ,通过超声心动图评价恢复情况。结果 41例患者中死亡2例(4.9%),围术期发生肾功能不全2例(4.9%)。术后随访12～66个月,心功能均恢复至Ⅰ～Ⅱ级。肺动脉压力术后1周显著下降(91 mmHg±19 mmHg vs 37 mmHg±10 mmHg),3个月后进一步下降至(35±13)mmHg。结论瓣膜置换术可显著降低瓣膜病患者的肺动脉压力,进而改善其心功能。在术前准备周密、手术方案合理、积极预防和处理好术后并发症的前提下,重度肺动脉高压并不显著增加机械瓣膜置换手术的病死率。

Perioperative management of mechanical valve replacement in patients with valvular heart diseases complicated by severe pulmonary artery hypertension

Objective To summarize the perioperative management of mechanical valve replacement in patients with valvular heart diseases complicated by severe pulmonary artery hypertension.Methods The clinical data of 41 patients with valvular heart diseases complicated by severe pulmonary artery hypertension(PASP >70mmHg) performed mechanical valve replacement recently in the hospital were analyzed.Among 21 of them were cases with MVR(mitral valve replacement,19 cases of rheaumatic diseases,2 cases of prolapse).,4 cas...