主动脉瓣与二尖瓣双瓣置换术临床研究

目的回顾分析84例主动脉瓣与二尖瓣双瓣置换术患者的临床资料,探讨提高手术疗效的经验与方法。方法全组均为主动脉瓣及二尖瓣联合病变,本组84例病例均是在气管内插管＋静脉复合麻醉下,经胸正中切口,常规建立体外循环,采用右心房-房间隔径路,先置换二尖瓣,再置换主动脉瓣。有合并三尖瓣关闭不全病例,同期行三尖瓣成形术。二尖瓣置换采用连续缝合,主动脉瓣置换采用间断褥式缝合。结果术后死亡5例（占5.96%）,12例出现术后并发症（占14.29%）,79例获得随访2个月-5年。74例随访者术后五年心功能Ⅰ-Ⅱ级,均能从事正常生活和工作。结论掌握准确的手术时机,积极的术前准备,改善心脏功能,术中良好的心肌保护与适当的瓣膜匹配,以及术后的积极管理等,可大大提高手术成功率,降低病死率。

Clinical therapeutic effects of replacement of aortic and mitral valves in 84 cases

Objective To explore operative methods and clinical therapeutic effect of replacement of aortic and mitral valves.Methods 84 patients with combined aortic and mitral disease were anesthetized in general anesthesia,and then cardiopulmonary bypass was established. Mitral valve was replaced first through the right atria and atrial septum,and then aortic valve was replaced. The patients with tricuspid insufficency received Devegra operations.Results Five cases died (5.96%),postoperative complications happened i...