【摘要】：血管內(nèi)溶血是心臟瓣膜術(shù)后并發(fā)癥之一。隨著醫(yī)學(xué)技術(shù)發(fā)展,嚴(yán)重瓣膜相關(guān)血管內(nèi)溶血發(fā)生率顯著降低,但亞臨床溶血仍普遍存在。該并發(fā)癥主要發(fā)生機(jī)制為瓣膜術(shù)后局部結(jié)構(gòu)改變,導(dǎo)致非生理性血流形成,剪應(yīng)力增高,引發(fā)紅細(xì)胞破碎、血管性血友病因子減少,血小板功能異常。溶血的發(fā)生及嚴(yán)重程度受人工瓣膜、手術(shù)操作和原發(fā)病等多方面因素影響。早期主要原因?yàn)榘昴ぴO(shè)計缺陷和質(zhì)量問題,現(xiàn)階段以手術(shù)操作并發(fā)癥所致為主。患者同時具有瓣膜功能異常和血管內(nèi)溶血相關(guān)臨床表現(xiàn),治療以糾正原發(fā)病為主,結(jié)合患者情況個體化用藥,嚴(yán)重者考慮再次手術(shù)。近年來,介入下瓣膜置換術(shù)和瓣周漏修補(bǔ)術(shù)在世界范圍內(nèi)逐漸開展,相關(guān)研究及證據(jù)資料有限,值得進(jìn)一步關(guān)注。
[Abstract]:Intravascular hemolysis is one of the complications after cardiac valve operation. With the development of medical technology, the incidence of severe valvular related intravascular hemolysis decreased significantly, but subclinical hemolysis was still prevalent. The main mechanism of this complication is that the local structure changes after valve operation, resulting in the formation of non-physiological blood flow, the increase of shear stress, the fragmentation of red blood cells, the decrease of von Willebrand factor, and the abnormal platelet function. The occurrence and severity of hemolysis are affected by prosthetic valves, surgical procedures and primary diseases. The main causes in the early stage were valve design defects and quality problems. Patients also have valve dysfunction and intravascular hemolysis related clinical manifestations, the main treatment is to correct the primary disease, combined with the individual use of patients, serious cases consider reoperation. In recent years, interventional valvular replacement and perivalvular leakage repair have been carried out all over the world.
【作者單位】： 中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院北京協(xié)和醫(yī)院麻醉科;
【分類號】：R654.2

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本文編號：2272107