摘要
目的：介绍二尖瓣闭式扩张术后的瓣膜替换术经验。方法：我院自１９７７年１１月至１９９３年１２月期间共行二尖瓣闭式扩张术后瓣膜替换术２２９例（男１４８例，女８１例）。瓣膜替换时平均年龄４３．９５±６．６０岁。其中急诊手术５例，择期手术２２４例，两次手术间隔为１２．９６±６．７９年。均在低温体外循环下手术，其中二尖瓣替换术２０８例（９０．８３％）；二尖瓣及主动脉瓣双瓣替换术２１例（９．１７％）。结果：总手术死亡率７．４２％，１９８７年前死亡率为２３．６８％，而近３年死亡率仅０．８８％（１／１１３）。结论：掌握好手术时机；注重心肌保护；避免广泛游离心包粘连；采用右房、房间隔切口显露二尖瓣，连续缝合法替换二尖瓣，使手术时间缩短；以及正确的术后处理等，均是降低死亡率的重要因素。
Objective:To sum up experience of heart valve replacement after closed mitral commissurotomy.Methods:Two hundred and twenty-nine Patients underwent heart valve replacement(HVR) after closed mitral commissurotomy(CMC)between November 1977 and December 1993.The average age was 42.95±6.60(28～65) years at HVR with emergency operation in 5 cases, and selective in the rest.The av erage interval between the two operations was 12.96±6.79(0.7-33) years.All of the operations were per formed under hypothermia and CPB. Mitral valve replacement was done in 208 cases(90.82%); mitral and aortic valve replacements in 21(9.17%).Results:There were 17 early deaths in this group. The overall operative mortality was 7.42%. howev er it had decreased from 23.68%(9/38)in the years before 1987 to 0.88%(1/113)in the recent years.4 cases died of low cardiac output syndrome.1 of ventricular fibrillation,3 of renal failure,4 of infection,1 of respiratory failure and 1 of hemorrhage.Conclusions:The factors for decreasing hospital mortality of HVR include:preoperative evaluation of heart functional status; avoiding too much dissection of the adherent pericardium during operation;ade quate approach to expose the mitral valve through right atrial and atrial Septal incisions;running suture of the mitral prosthesis to shorten the aortic cross-clamping time;and prompt and correct postoperative care of the patients.
出处
《中国循环杂志》
CSCD
1996年第1期15-17,共3页
Chinese Circulation Journal
