合并心脏恶病质瓣膜病的围手术期处理

目的：探讨合并心脏恶病质瓣膜疾病的围手术期处理，提高对其外科治疗的成功率。方法：收集1992～2001年间符合心脏恶病质综合征诊断标准的风心瓣膜病24例。结果：二尖瓣置换术15例，主动脉瓣及二尖瓣置换术9例，同时三尖瓣成形术24例。术后并发症13例，包括低心排血量综合征、室性心律失常和多器官功能衰竭，死亡4例(17％)。结论：手术成功关键在于重视围手术期处理：调整全身及心功能达最佳状态，术中重视心肌保护及三尖瓣功能纠正，术后积极防治低心排血量和多器官功能衰竭。

The Perioperative Management in Valvular Disease Associated with Cardiac Cachexia

Objective: To study the perioperative management in valvular disease associated with cardiac cachexia, in order that the success rate of surgical therapy of the disease will be increased. Methods: Data of 24 cases of rheumatic valvular disease with cachexia syndrome of being diagnosed on the basis of widely accepted definition were collected. Results: 15cases had their mitral valve replaced, the other 9 cases had both aortic and mitral valves replaced, and simultaneously each of the 24 patieuts above underwent the tricuspidoplasty too. Postoperative complications occurred in 13 cases including low cardiae output syndrome, ventricular arrhythmia and MOF. 4 patients failed to survive (mortality 17%). Conclusion:Succeeding in surgical therapy lies on the proper perioperative care ie, preoperative improvement in physical constitution and particularly in cardiac function as good as possible, during the course of operation close attention being paid to protect the myocardium and to keep the ability of tricuspid value vigorous, and aggressively postoperative prevention against and treatment of low cardiac output and MOF.