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风湿性二尖瓣狭窄合并小左心室的外科围术期处理策略
刘建平,张永恒,唐小娇,周琴,江继端,曹霖,龚晟,张强
0
(遂宁市中心医院 心血管外科;遂宁市中心医院 手术麻醉部;遂宁市中心医院 重症监护室)
摘要:
【摘要】目的 探讨风湿性二尖瓣狭窄合并小左心室围术期的处理策略。方法 收集2013年1月~2016年1月遂宁市中心医院心血管外科19例因风湿性二尖瓣狭窄合并小左心室行手术治疗患者的临床资料,总结围术期处理经验及策略。结果 本组19例患者中18例手术顺利完成,1例因术中左心室破裂死亡;1例术后因低心排综合征导致多脏器功能不全死亡,死亡率10.5%。术后低心排血量综合征4例,心律失常 4例,肺部感染6例,急性肾功能不全2例,切口感染 1例,均给予相应的处理。出院后随访 17例,随访时间为 8~44个月,均正常存活。心功能恢复至Ⅰ级10例, Ⅱ级 7 例。心脏彩超提示:左心室舒张末期内径(LVEDD)(46.5±5.4)mm,射血分数 48%~75%。 结论 风湿性二尖瓣狭窄合并小左心室患者,临床症状严重,一旦围手术期处理不当,术后极易发生低心排血量综合征、肺动脉高压危象及室性心律失常等严重并发症。术前积极维护心功能、纠正全身情况,术中正确决策手术方式,术后加强监护、合理应用缩血管药物及适当补液纠正低心排血量综合征、积极处理心律失常,可降低术后早期并发症发生率及死亡率。
关键词:  风湿性心脏病  二尖瓣狭窄  小左心室  外科治疗  临床分析
DOI:
基金项目:四川省卫计委科研课题(130491)
Clinical analysis on the surgical treatment for rheumatic mitral stenosis associated with small left ventricle
LIU Jianping,ZHANG Yongheng,TANG Xiaojiao,ZHOU Qin,IANG Jiduan,CAO Lin,GONG Sheng,ZHANG Qiang
(Department of Cardiovascular Surgery, Central Hospital of Suining;Department of Operation and Anesthesia, Central Hospital of Suining;Department of ICU, Central Hospital of Suining,)
Abstract:
【Abstract】Objective To discuss the treatment strategy for rheumatic mitral stenosis associated with small left ventricle during the perioperative period. Methods The clinical data of 19 patients received surgical treatments due to rheumatic mitral stenosis associated with small left ventricle from January, 2013 to January, 2016 were selected. The experience and knowledge of treatment during the perioperative period were explored. Results Among the 19 patients, 18 patients had the surgeries completed successfully and 1 patient died from left ventricle rupture during the surgery. 1 patient died from multiple organ dysfunction caused by low cardiac output syndrome after the surgery, and the mortality was 10.5%. After the surgeries, 4 cases reported low cardiac output syndrome, 4 cases reported arrhythmia, 6 cases reported pulmonary infection, 2 cases reported acute renal insufficiency and 1 case reported incision infection. All of the 17 cases had been given corresponding treatments and postdischarge followups for a followup period of 8~44 months. All patients reported normal survival. 10 cases had the cardiac function restored to level I and 7 cases restored to level II. Ultrasonic cardiogram noted: the left ventricular and diastolic diameter(LVEDD) was 46.5±5.4mm, and the ejection fraction was 48%~75%. Conclusion The condition of patients with rheumatic mitral stenosis associated with small left ventricle is critical, if not treated properly during the perioperative period, it will be extremely easy for the patients to have severe postoperative complications, such as low cardiac output syndrome, pulmonary hypertensive crisis and ventricular arrhythmia and so on. The active maintenance of the cardiac function and the correction of the general situation before the surgery, the accurate determination of the surgical procedures during the surgery, the intensive postoperative care, the rational use of vasoconstrictor drugs, the proper fluid infusion to correct low cardiac output syndrome, and the active treatment of arrhythmia are the keys to bring down the incidence and mortality of early complications after surgeries.
Key words:  Rheumatic heart disease  Mitral stenosis  Small left ventricle  Surgical treatment  Clinical analysis

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