摘要
目的:探讨风湿性心脏病(简称风心病)并发恶病质的围手术期处理. 方法:对33例患者进行手术治疗,其中二尖瓣置换23例,二尖瓣、主动脉瓣置换10例.术前充分准备,很好保护心肌;术中正确使用血管活性药物和机械通气;术后严密监护和围手术期营养支持. 结果:死亡2例(6.1%),术后早期生存31例(93.9%),出院时心功能均为Ⅲ级,腹水完全消退,肝脾明显缩小,肺淤血明显改善.随访表明,31例生存超过1年,心功能均为Ⅰ～Ⅱ级,体重平均增加14.1%,心胸比率平均为61.7%. 结论:尽管手术风险很大,但只要术前准备充分,术后严密监护和加强围手术期营养支持,患者出院时心功能和全身情况明显改善,说明早期效果满意,但并发症发生率较高,说明围手术期处理较困难.
： Objectives:To study the perioperative management of rheu matic heart disease-associated cachexia. Methods：Thirty-three p atients with rheumatic heart disease associated cachexia were operated, mitral v alve replacement was performed in 23 cases and double valve replacement in 10 ca ses. Results: There were two deaths (death rate 6.1%) in the posto perative period because of arrhythmia. The mortality rate was 42.4%. Heart funct ional class and the general conditions of the 31 early survivors were significan tly improved. The liver and renal functions became normal. The early results wer e satisfactory, but the complication rate was high. Conclusions: Th ere are some important factors affecting the operative results of rheumatic hear t disease patients with cardiac cachexia, they are: sufficient preoperative prep aration, improvement of patients' general condition and cardiopulmonary function , enhance intraoperative myocardial protection and uneventful CPB, complete corr ection of tricuspid regurgitation, giant left atrial plication, correct use of v asoconstrictor and vasodilator, reasonable application of mechanical ventilation , intensive postoperative management, and perioperative nutritional support.
出处
《医学研究生学报》
CAS
2001年第5期413-415,共3页
Journal of Medical Postgraduates
