医学毕业论文风湿性心脏病二尖瓣重度狭窄合并小左心室的外科治疗.docVIP

风湿性心脏病二尖瓣重度狭窄合并小左心室的外科治疗 作者：邹小明，蔡开灿，刘鑫 【摘要】 目的总结风湿性心脏病二尖瓣重度狭窄伴小左心室病人外科治疗的围手术期特点。方法对我院2002年1月至2007年12月行二尖瓣替换（MVR）的586例病例资料进行回顾性分析，其中重度二尖瓣狭窄伴小左心室62例。根据手术前是否使用前列腺素E1（PGE1）将小左心室患者随机分为：A组（未使用PGE1）26例；B组（使用PGE1）36例。并且对手术后主要并发症及病死率进行对照分析研究。结果术后早期的总死亡率为2.9%，非小左心室的死亡率为1.5%，而小左心室的死亡率为14.5%。小左心室患者中A组死亡5例，病死率为19.2%；B组死亡4例，病死率为11.1%。A组术后低心排血量综合征、肺部并发症的发生率及病死率均高于B组（P＜0.05）。结论重度二尖瓣狭窄伴小左心室仍是影响患者术后恢复及生存的高危因素。术前注重降低肺动脉压，加强围手术期处理，可以有效减少并发症及早期病死率。 【关键词】 二尖瓣狭窄；小左心室；二尖瓣替换 Abstract: Objective To summarize the perioperative features of surgical treatment in patients with severe mitral stenosis associated with small left ventricle. Methods Mitral valve replacement (MVR) was taken for 586 patients with severe rheumatic mitral stenosis from January, 2002 to December, 2007， of witch 62 patients belong to SMS associated with small LV. All these cases were analyzed retrospectively. According to use or not use of prostaglandin E1 (PGE1) in the preoperative, They were divided into two groups: 26 cases in the group A (unused prostaglandin E1), 36 cases in the group B (used prostaglandin E1). Compared and analyzed statistically about the major complications of postoperative and the mortality. Results The total mortality was 2.9% in the postoperative early, the mortality of the nonsmall left ventricle was 1.5%, and the mortality of the small left ventricle was 14.5%. In the small left ventricle group, the postoperative mortality was 19.2%(5/26) in the group A; and 11.1%(4/36) in the group B. The incidence of low cardiac output syndrome and the complications, and the mortality in the group A were higher than that in the group B (P＜0.05). Conclusions SMS associated with small left ventricle still be considered as a high risk factor for recovery and survival after operation. To reduce the pulmonary hypertension in the preoperative and strengthen the perioperative management can effectively reduce the complications and early mortality. Keywords: mitral stenosis; small left ventricle; mitral valve r