中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

25 例急诊心脏瓣膜置换术的临床体会

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目的 总结急诊心脏瓣膜置换治疗危重心脏瓣膜病患者的临床经验。 方法 回顾性分析 2008 年 4 月至 2018 年 4 月内科药物治疗无效的接受急诊手术治疗 25 例重症瓣膜病患者资料(除外主动脉夹层、急诊搭桥同期行瓣膜手术及心脏肿物累及瓣膜手术的病例)。其中,男 14 例、女 11 例,平均年龄为(45.0±14.6)岁。均合并严重的心功能不全(Ⅳ级),8 例术前需要机械通气。所有患者均急诊在全身麻醉、体外循环下行瓣膜置换术。感染性心内膜炎 11 例,均可见明显赘生物,其中 4 例合并瓣周脓肿;瓣膜重度狭窄 8 例,急性瓣膜重度关闭不全 6 例,包括急性腱索断裂 4 例、二尖瓣成形术后失败再次急诊行置换术 2 例。 结果 所有 25 例患者手术后住院期间死亡 6 例(24.0%),其中 5 例死于为多脏器功能衰竭,1 例死于感染复发导致的败血症。另有 1 例术中出现Ⅲ度房室传导阻滞安装永久性起搏器,2 例术后早期出现脑出血,经积极治疗后康复,其余均顺利出院。随访 1~120 个月,随访率 100%(19/19),1 例术后 3 个月出现肺部感染死亡,其余患者的心功能均改善明显(Ⅰ级 3 例,Ⅱ级 15 例)。 结论 手术指征明确的重症瓣膜患者在内科药物治疗无效时应积极选择急诊手术治疗,不仅能够挽救患者的生命,还能提高患者远期生存质量。

关键词: 心脏瓣膜; 急诊手术; 危重; 心功能不全

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