728例心脏瓣膜病变的外科治疗

目的进一步提高心脏瓣膜病手术治疗的成功率。方法回顾分析2001年9月至2007年5月,728例心脏瓣膜病人手术治疗,男334例,女394例。年龄12-85岁,平均52.7±6.3岁。主动脉瓣置换（AVR）＋二尖瓣置换（MVR）＋三尖瓣成形（TVP）83例;AVR＋MVR125例;AVR130例;AVR＋冠状动脉旁路移植（CABG）5例;MVR＋TVP114例;MVR243例;MVR＋CABG4例;带瓣升主动脉置换加冠状动脉移植14例（Bentall术）;二尖瓣成形（MVP）6例;三尖瓣置换（TVR）4例。结果发生左室破裂3例,抢救不及死亡;瓣周漏1例,再次换瓣治愈;多脏器功能衷竭7例,抢救成功2例;低心排综合征5例,抢救成功5例;心律失常82例,其中室上性心动过速32例,均经药物控制;室性期前收缩或室性心动过速50例,经药物和电复律39例;自动复律8例,死亡3例;不明原因溶血3例,均未能存活。全组手术死亡14例,手术病死率1.92%。结论加强围手术期处理,改进手术技术可进一步提高心脏瓣膜疾病的手术成功率。

Clinical results of 728 cases of heart valve replacement

Objective To improve survival rate of valve surgery.Methods From Sep.2001 to May 2007,there were 728 cases of valve surgery,of which 334 male and 394 female(age:12 to 85 years old,average 52.70±6.3),there were 83 cases of aortic valve replacement+mitral valve rep;acement+tricuspid valvuloplasty(AVR+MVR+TVP),125 cases of AVR+MVR,130 cases of AVR,5 cases of AVR+CABG,14 cases of MVR+TVP,243 cases of MVR,4 cases of MVR+CABG,114 cases of Bentall therapy ,6 cases of MVP and 4 cases of TVP.Results Three cases of left ventricular failure,dead after emergency surgery;1cases of perivalvular leakage,cured after reoperation;7 cases of multiple organ dysfunction syndrome(MODS),2 survived after emergency surgery;5 cases of low cardiac output syndrome,all survived after emergency surgery;82 cases of arrhythmia,of which 32 was supraventricular(controlled by medicine),50 was ventricular(39 survived after medicine cure and cardioversion,3 dead);3 cases of unknown haemolysis,all dead.14 cases died during surgery,the mortality rate is 1.92%.Conclusions To improve survival rate of valve surgery,we need better perform during surgery and improve surgical technique.