【摘要】 目的探讨再次心脏手术的处理方法及手术风险,研究制定相应对策。方法对30例心脏病患者行再次手术治疗。按首次手术类型分两组:介入手术组13例均行二尖瓣球囊扩张术;外科手术组17例,包括二尖瓣闭式扩张术8例、二尖瓣机械瓣置换术5例、室间隔缺损修补术4例。再次手术方式为:单纯二尖瓣置换术17例,二尖瓣并主动脉瓣置换术4例,二尖瓣二次置换术2例,二尖瓣口血栓清除术1例,单纯三尖瓣成形术2例,室缺残余漏修补4例。两次手术间隔时间1月~15年,平均(6.8±7.9)年。结果介入手术组再次术后无严重并发征及死亡发生;外科手术组再次术后出现低心排综合征4例、术后出血3例、严重心律失常3例,其中2例死亡。首次手术为介入组的转机时间、呼吸机辅助时间均短于外科手术组(P<0.05);而两组在低心排综合征、术后出血、严重心律失常的发生率及死亡率等方面比较无差异(P>0.05)。结论首次心脏外科手术病例,其再次手术风险高、难度大。应充分认识心脏再次手术的危险性,术前应对危险因素、手术指征及手术时机分析评估,制定相应对策,运用良好心肌保护、灵活有效的技术手段及减少出血等措施,有利于提高手术成功率。更多还原

【Abstract】 Objective To discuss and summarize the countermeasure of the cardiac re-operation.Methods The medical records of 30 cases of cardiac re-operation were analyzed from October 2001 to October 2007.All the patients were divided into two groups according to the first operations: the interventional group including percutaneous balloon mitral valvoplasty in 13 cases,and the surgical group including mitral valve closed expansion in 8 cases,mitral valve replacement in 5 cases,and repair of ventricular septal defect in 4 cases.The second operation included 17 cases of mitral valve replacement,4 of mitral valve and aortic valve replacement,2 of mitral valve re-replacement,1 of mitral valve thrombectomy,2 of tricuspid annuloplasty and 4 of direct remnant prothesis of VSD.The duration between two operations was 1 month to 15 years,(6.8±7.9) years in average.Results There was no severe complication in the interventional group.And in the surgical group,there were 4 cases of low cardiac output syndrome,3 of postoperative bleeding,3 of serious cardiac arrhythmias.1 case of low cardiac output syndrome and 1 case of bleeding died.Conclusions It is critical in cardiac re-operation,especially,in cardiac valve surgery and direct remnant prothesis of VSD.The physical condition of patients should be improved as better as possible before re-operation.It is important of myocardial protection,prevention of bleeding and appropriate use of drugs for improving the surgical efficacy.更多还原