高危心脏瓣膜疾患310例围术期处理

PERIOPERATIVE MANAGEMENT OF 310 HIGH RISK PATIENTS WITH VALVULAR HEART DISEASE

Three hundred and ten high risk patients with valvular heart disease were operated on in our hospital from December 1978 through June 1991. All the high risk patients were classified into three types: 1. those with mitral lesions, or combined with aortic lesions, and severe left or right ventricular dysfunctions (139 cases); 2. mitral lesions and aortic lesions combined with organic tricuspid lesions, and severe left and right ventricular dysfunctions (19 cases); 3. valvular lesions combined with dysfunction of other important organs and/or acute hemodynamic changes or cardiogenic shock (152 cases). Perioperative managements: Preoperatively digoxin, diuretics and vasodilator were used to improve the cardiac function and systemic state. During operation, myocar-dial protection, thorough correction of the cardiac valve lesions, and optimum and match of synthetic cardiac valve were emphasized. The major points of early postoparative care included mechanical assistant ventilation, the use of positive myocardial inotropic drugs, vasodilator and diuretics. There were thirty two early deaths (10.32%) postoperatively. Among them, 56.2% died of cardiogenic causes and 43.8% of dysfuntions of other important organs. This paper emphatically discussed the perioperative managements of high risk patients with valvular heart disease in an effort to improve the operative results.