【摘要】：目的分析二尖瓣置換術(shù)后遠(yuǎn)期再行主動脈瓣置換術(shù)的原因、診療及療效,探討二尖瓣置換術(shù)后再行主動脈瓣置換術(shù)的手術(shù)經(jīng)驗(yàn)、圍術(shù)期處理,為臨床診療提供參考及借鑒。方法回顧性分析自2008年1月1日至2014年12月31日期間就診福建醫(yī)科大學(xué)附屬協(xié)和醫(yī)院心臟外科55例曾行二尖瓣機(jī)械瓣置換術(shù)史因再發(fā)主動脈瓣膜病變而入院接受主動脈瓣置換術(shù)的患者資料,其中男21例、女34例,年齡(50.6±7.0)歲,距離首次心臟手術(shù)時間15.4±5.4年,所行手術(shù)包括主動脈瓣置換術(shù)(AVR)51例,雙瓣置換術(shù)(DVR)4例,同期行三尖瓣成形術(shù)10例,同期行左房折疊1例。瓣膜全部為雙葉機(jī)械瓣。治療前后參照紐約心臟病協(xié)會(NYHA)心功能標(biāo)準(zhǔn)對患者進(jìn)行心功能評級。對所有出院患者進(jìn)行門診復(fù)查和電話隨訪。結(jié)果二尖瓣置換術(shù)后再發(fā)主動脈瓣病變而需行主動脈瓣置換術(shù)的主要原因包括主動脈瓣風(fēng)濕性病變加重(70.90%)、退行性主動脈瓣病變(25.50%)、感染性心內(nèi)膜炎贅生物形成(3.60%)。住院期間死亡2例,死亡原因?yàn)槎嗯K器功能衰竭,圍手術(shù)期死亡率3.64%。非死亡病例中ICU監(jiān)護(hù)時間1-7d,平均2.4±1.1d,住院時間10-44d,平均住院日20.5±10.1d。術(shù)后發(fā)生并發(fā)癥者25例(45.5%),術(shù)后平均隨訪時間30月,隨訪期間無死亡,病人臨床癥狀緩解明顯,心功能得到一定程度恢復(fù),其中心功能I級者11例,心功能II級者32例,心功能III級者10例。術(shù)前術(shù)后彩色超聲心動圖檢查部分指標(biāo)對比示:術(shù)后1周即可發(fā)現(xiàn)LVEDD和LA較術(shù)前明顯回縮(P0.05),而LVEF、LVFS、心功能分級手術(shù)前后差異均無顯著性(P0.05),出院后3月LVEDD、LA、LVEF、LVFS、LVFS、心功能分級恢復(fù)程度顯著(P0.05)。結(jié)論1、主動脈瓣風(fēng)濕性病變加重、退行性主動脈瓣病變、感染性心內(nèi)膜炎贅生物形成這三方面是二尖瓣置換術(shù)后再發(fā)主動脈瓣病變而需行主動脈瓣置換術(shù)的主要原因。2、重視術(shù)前高危因素的存在、術(shù)前注意改善心功能、選擇正確的手術(shù)時 機(jī)、術(shù)中注意心肌保護(hù)、合理的手術(shù)方法及適當(dāng)?shù)膰中g(shù)期治療,二尖瓣置換術(shù)后再行主動脈瓣置換能取得良好的手術(shù)效果。3、術(shù)后應(yīng)做好出院指導(dǎo)及隨訪等工作,二尖瓣置換術(shù)后遠(yuǎn)期再行主動脈瓣置換術(shù)近期療效顯著,但遠(yuǎn)期療效有待進(jìn)一步研究。
[Abstract]:Objective to analyze the causes, diagnosis and curative effect of aortic valve replacement after mitral valve replacement, and to discuss the experience and treatment of aortic valve replacement after mitral valve replacement, so as to provide reference for clinical diagnosis and treatment. Methods from January 1, 2008 to December 31, 2014, 55 patients who had undergone mechanical mitral valve replacement with recurrent aortic valve disease were retrospectively analyzed. Data of patients undergoing aortic valve replacement, There were 21 males and 34 females, aged (50.6 鹵7.0) years, who were 15.4 鹵5.4 years from the first cardiac surgery. The operation included aortic valve replacement (AVR) in 51 cases, double valve replacement in (DVR) (4 cases), aortic valve replacement (AVR) in 51 cases and double valve replacement (DVR) in 4 cases. Tricuspid valvuloplasty was performed in 10 cases and left atrial folding in 1 case at the same time. The valves are all double-lobed mechanical valves. Cardiac function was rated according to the New York Heart Association (NYHA) cardiac function criteria before and after treatment. All discharged patients were reviewed by outpatient and followed up by telephone. Results the main causes of aortic valve replacement after mitral valve replacement were the aggravation of aortic valve rheumatic disease (70.90%) and degenerative aortic valve disease (25.50%). Neoplasm formation in infective endocarditis (3.60%). Two cases died during hospitalization, the cause of death was multiple organ failure, the perioperative mortality was 3.64%. The monitoring time of ICU was 1 ~ 7 days (average 2.4 鹵1.1 days), the hospitalization time was 10-44 days, and the average hospitalization days were 20.5 鹵10.1 days. The postoperative complications occurred in 25 cases (45.5%). The average follow-up time was 30 months. There was no death during the follow-up period. The clinical symptoms of the patients were obviously relieved and the cardiac function recovered to a certain extent. There were 32 cases of II grade and 10 cases of III grade of cardiac function. The results of color echocardiography before and after operation showed that LVEDD and LA were significantly retracted at 1 week after operation (P0.05), but there was no significant difference in LVEF,LVFS, cardiac function grading before and after operation (P0.05). Three months after discharge, the degree of LVEDD,LA,LVEF,LVFS, cardiac function grade recovered significantly (P0.05). Conclusion 1. The main causes of aortic valve replacement after mitral valve replacement are aggravated rheumatic aortic valve disease, degenerative aortic valve disease, and neoplasm formation of infective endocarditis. Attention should be paid to the existence of high risk factors before operation, to the improvement of cardiac function before operation, to the selection of correct operative timing, to the protection of myocardium during the operation, to reasonable surgical methods and to appropriate perioperative treatment, After mitral valve replacement, aortic valve replacement can get good results. 3. After mitral valve replacement, we should do a good job of discharge guidance and follow up, and the short term effect of mitral valve replacement after mitral valve replacement is remarkable. But the long-term effect needs further study.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.2

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本文編號：2403253