【摘要】 【目的】报道28年来中山大学附属第一医院2000例瓣膜置换术的结果和体会,以进一步提高手术疗效。【方法】1976年5月至2004年8月共为2000例心脏瓣膜病患者施行了瓣膜置换术。手术方式:二尖瓣替换术(MVR)1325例(66.2%),主动脉瓣替换术(AVR)324例(16.2%),主动脉瓣及二尖瓣同期替换术(AVR及MVR)322例(16.1%),三尖瓣替换术(TVR)29例(1.5%)。术后随访1个月～28年,平均(10.2±5.3)年,失访283例(15.1%)。【结果】术后早期死亡129例(6.45%),其中1976年至1994年为95例(9.5%),1995年至2004年为34例(3.4%),前后两组差别有统计学意义(字 2=12.62,P <0.001)晚期死亡288例(1.9%病人年),存活病人心功能明显改善。【结论】选择适当的手术时机,完善和改进体外循环技术,加强术中的心肌保护,不断改进和提高手术技巧,对适宜病例施行保留瓣下结构的二尖瓣替换手术(MVRP),对合并三尖瓣中、重度关闭不全的病例予以三尖瓣整形术,加强术后监护,及时处理早期并发症是提高手术疗效的重要措施。为提高瓣膜置换术后病人的远期生存率,尤其应该重视加强健康宣教及门诊随访,并及时调整抗凝剂用量。更多还原

【Abstract】 To review the 28-year experiences of 2 000 cases of heart valve replacement in The First Affiliated Hospital of SUN Yat-sen University for improving the effect of surgical treatment. From May 1976 to August 2004, we had implanted heart valve prosthesis in 2 000 patients, in the mitral (n =1 325, 66.2%), aortic (n =324, 16.2%), aortic and mitral (double valve replacement) (n =322, 16.1%), and tricuspid (n =29, 1.5%). The patients were followed up during the course from 1 month to 28 years (mean 10.2±5.3 years), and 283(15.1%) patients were lost in this period. The hospital mortality was 6.45% (129 patients)overall, 9.5% (95 patients) from 1976 to 1994, and 3.4% (34 patients) from 1995 to 2004. There is significant difference(2 =12.62, P <0.001) between the two groups. Two hundred and eighty-eight patients died during the late follow-up (1.9% patient years). In the survival patients, the heart function was improved significantly. [Conclusion]To have the better outcome of surgical treatment, we consider the importance is to have well-timed surgical therapy, to improve the techniques of extracorporeal circulation, surgical treatment, and myocardium preservation, to perform mitral valve reservation procedure (MVRP) for proper patients, to repair tricuspid valve in the patients with moderate or severe tricuspid insufficiency, to intensify nursing and monitoring, and to manage complications in time. To improve the late survival rate of the patients with heart valve prosthesis, more attention should be paid to patienteducation, follow-up, and the usage of anticoagulant therapy.更多还原