急诊心脏瓣膜置换术41例的临床分析

目的总结重症瓣膜患者行急诊外科治疗的经验。方法1998年7月~2007年7月,对41例重症瓣膜患者急诊行心脏瓣膜置换术,其中感染性心内膜炎24例,二尖瓣重度狭窄7例,主动脉瓣重度狭窄2例,二尖瓣腱索断裂5例,主动脉瓣重度关闭不全合并瓦氏窦瘤破裂2例,介入术后主动脉瓣关闭不全1例。结果全组无手术死亡,术后2例再发机械瓣膜感染,4例并发肾功能衰竭,2例并发低心排,3例脑梗死症状加重,最终均死亡,其余顺利康复,死亡率为26.8%。结论符合手术指征的危重瓣膜患者应该急诊行瓣膜置换术,术后应注意肺脏和肾脏的保护,并且合理使用抗生素。

Analysis of urgent heart valve replacement operation: 41cases report

Objective To review the experience of urgent heart valve replacement operation in 41 patients.Methods 41 patients endured urgent heart valve replacement operation from July 1998 to July 2007.24 patients had infectious endocarditis,7 patients had severe mitral stenosis,2 patients had severe aortic stenosis,5 patients had rupture of chordae tendineae of mitral valve,2 patients had severe aortic valve regurgitation combind with ruptured aortic sinus aneurysm,and 1 patients had aortic valve regurgitation after intervention.Results There were no operative deaths.2 case died of mechanical valve infected,4 case died of acute renal failure,2 case died of low cardiac output syndrome,and 3 case dead because of the cerebral infarction aggravated.The mortality rate was 26.8%.Conclusion The patients who have severe valvular heart disease should accept the urgent valve replacement if they fit the operation indication,and the protection of lung and kidney should be noticed postoperation.