机械瓣膜功能障碍的原因及手术对策

目的分析机械瓣膜功能障碍的原因、外科手术方法,总结围手术期处理经验。方法1996年10月至2008年10月,阜外心血管病医院共施行人工机械瓣膜置换术12276例,其中有32例因机械瓣瓣膜功能障碍而进行再次手术治疗,男12例,女20例;年龄16～61岁,平均年龄43.8岁。再次手术均在全身麻醉低温体外循环下进行,手术方式为二尖瓣置换术16例,主动脉瓣置换术8例,二尖瓣＋主动脉瓣置换术3例,三尖瓣置换术2例,瓣膜角度矫正术2例,异物清除术1例;急诊手术13例,择期手术19例。结果全组呼吸机辅助呼吸时间为5.1～144.0h,中位时间15h;行气管切开2例。全组再次手术后死亡6例,病死率18.8%（6/32）;死亡原因为低心排血量综合征3例,多器官功能衰竭2例,恶性心律失常1例。发生并发症3例,分别为感染性心内膜炎1例、顽固性呃逆1例、切口感染1例,均治愈出院。结论机械瓣膜功能障碍是机械瓣置换术后严重并发症之一,应早发现、早诊断,尽早再次手术。

Causes and Reoperations of Mechanical Valve Dysfunction

Objective To analyze the causes of mechanical valve dysfunction and the reconstructive surgical procedure,and summarize the treatment experiences in perioperative period. Methods From October 1996 to October 2008,12 276 patients underwent mechanical valve replacement in Fu Wai Hospital. Thirty-two of them were reoperated because of mechanical valve dysfunction. There were 12 male and 20 female aged from 16-61 years with an average age of 43.8 years. All the reoperations were performed under hypothermic cardiopulmonary bypass,including 16 mitral valve replacement,8 aortic valve replacement,3 aortic and mitral valve replacement,3 tricuspid valve replacement,2 disc rotation and 1 excision of an excessive knot. There were 13 emergency operation and 19 elective operation. Results The time of ventilator assistant respiration was 5.1-144.0 hours.The median time was 15 hours and tracheostomy was needed in 2 cases. Six patients died after reoperations,the mortality rate was 18.8%（6/32）. Three died of low cardiac output syndrome,2 died of multiple organ failure and 1 died of malignant arrhythmia. Three cases had complications. There were 1 infective endocarditis,1 intractable hiccup and 1 incisional infection,respectively. They were all cured and discharged. Conclusion Prosthetic valve dysfunction is one of the serious complications after mechanical valve replacement. Early detection,early diagnosis and early reoperation are needed.