风湿性心脏病瓣膜置换术216例临床分析

目的总结216例风湿性心脏病的外科治疗经验。方法手术在全麻体外循环中度低温下进行，其中行二尖瓣置换术（MVR）130例，主动脉瓣置换术（AVR）28例，二尖瓣、主动脉瓣双瓣置换术（BVR）58例，三尖瓣成形术71例，左心耳结扎术24例，左房折叠术10例，左房血栓清除术25例。结果209例（96．8％）恢复出院，早期死亡7例（3．2％），死囚分别为低心排综合征2例、左室后壁及主动脉后壁破裂出血各1例、多脏器功能衰竭1例、恶性心律失常1例、脑栓塞1例。结论瓣膜置换术是治疗风湿性心脏瓣膜病的有效手段。充分的术前准备、加强心肌保护、提高和改进手术技术、术后有效的监护治疗，可显著提高手术疗效，减少术后并发症，降低死亡率，取得满意的临床效果。

The clinical analysis of heart valve prosthesis replacement in 216 patients with rheumatic heart disease

Objective To review the experience of 216 eases of heart valve prosthesis replacement from July 2004 to June 2009. Methods All 216 cases were underwent heart valve replacement under hypothermia and CPB. MVR 130 eases, AVR 28 cases, BVR 58 cases, DeVega valvoplasty were performed in 71 cases, left auricle ligation 24 cases, left atrium folden 10 cases, left atrium thrombus elimination 25 cases. Results 209 cases （96.8% of all eases） reeoverd and discharged,and 7 cases early death. Conclusion Valve prosthesis replacement is a reliably and effective remedy for rheumatic heart valve disease. Intensive myocardial protection, improving surgical technique and effective care and treatment after operation will improve long term effect, decrease complication and mortality.