【摘要】 目的　分析近年来心瓣膜替换术相关心瓣膜病种和病情变化。方法　总结 2 2 8例心脏瓣膜替换手术资料。结果　儿童、育龄妇女和中老年患者占 3 2 .0 %。术前Ⅰ级心功能占 1.8% ,Ⅱ级 2 4.6% ,Ⅲ级 68.9% ,Ⅳ级 4.8%。主动脉瓣替换术 (AVR)占 15 .8% ,二尖瓣替换术 (MVR) 60 .5 % ,MVR并AVR 2 1.5 % ,三尖瓣替换术 (TVR) 2 .2 %。 5例行保留全瓣下结构的二尖瓣替换手术 (MVRP) ,8例MVRP失败 ,术中改行经典MVR。术后早期病死率 4.8% ,心功能Ⅳ级病例病死率 2 7.3 %。病变以瓣膜增厚为主、钙化和挛缩等较少。结论　适当提前手术时机有助于提高手术疗效。MVRP应保持瓣膜、附件和左室游离壁的“J”关系。生物瓣仍有相当的应用前景更多还原

【Abstract】 Objective To observe the changes in etiology and pathology of cardiac valve diseases for cardiac valve replacement in recent 3years. Methods 228 patients with cardiac valve replacement in our division from Jan.1997 to Oct.1999 were reviewed. Results Cardiac function classification operation was as followings: Grade Ⅰ:4 patients(1.8%),Grade Ⅱ: 56 patients(24.6%),Grade Ⅲ: 157 patients(68.9%), Grade Ⅳ: 11 patients(4.8%). The procedure of operations was as followings: 36 patients with aortic valve replacement(AVR) (15.79%), 138 patients with mitral valve replacement (MVR)(60.53%), 49 patients with both aortic and mitral valve replacement (21.49%), 5 patients with tricuspid valve replacement (2.19%). 5 patients were adopted to MVRP. 8 patients were tried to be adopted to MVRP but failed, and the procedure was changed to classic MVR during the operations. 11 patients(4.8%) died during the early period after operations, including 3 patients with heart function grade Ⅳ. The main pathological changes of valves were valve thickening, valve calcifying and contraction were few. The numbers of children, women in reproductive period and elder patients (ages over 55 year old) increased. Conclusion Choosing a suitably earlier operation time is important for improving the effects of operations. As to the procedure of MVRP, the principle is to request the "J" relation of the mitral valve and its attachment with the free wall of left ventricle. Bio-prostheses have a good prospect.更多还原