成人心脏瓣膜置换术后90例治疗体会

目的总结90例成人心脏瓣膜置换术早期治疗上的一些体会，探讨提高瓣膜置换术后早期生存率的措施。方法选择2011年1月至2011年8月行瓣膜置换术的患者90例，术后入住ICU，呼吸机辅助呼吸，连续多项指标监测,常规血管活性药物辅助，维持血压在术前水平，控制心室率80~100次/分。结果二次开胸止血患者5例，大量心包积液患者5例，恶性心律失常患者3例，肺部感染患者3例，急性肾功能衰竭患者4例。术后早期存活患者共85例（存活率94.44%），死亡5例（5/90，5.55%）。结论对心脏瓣膜病患者的手术，特别是重症患者，提高手术技能、加强术中心肌保护、严密术后治疗的各种环节，及时处理早期并发症是提高患者早期生存率的关键。

Clinical Treatment of Adult Heart Valve Replacement Surgery 90 Cases

Abstract： Objective To summarize 90 cases of adult cardiac valve replacement early experiences of treatment, to explore the early survival rate increased after valve replacement measures. Methods 90 cases of patients in 2011 January ~2011 year in August for valve replacement, postoperative stay in ICU, mechanical ventilation, for a number of indicators for monitoring, routine of vasoactive drugs, to maintain blood pressure in the preoperative level, controlling ventricular rate 80~100 times/points. Results Two patients with thoracic bleeding in 5 cases, 5 cases of pericardial effusion, 3 cases of patients with malignant arrhythmia, pulmonary infection in 3 cases, 4 cases of patients with acute renal failure. Early survival in patients with a total of 85 cases of postoperative （ the survival rate was 94.44%）, 5 cases of death （5／/90,5.55%）. Conclusion The patients with valvular heart disease operation, especially in critically ill patients, improve operation skills, various aspects of strengthening the intraoperative myocardial protection, close postoperative treatment, timely treatment of complications in early stage is the key to improve the survival rate of patients in early stage.