摘要目的 总结心脏瓣膜置换术的手术效果,探讨影响手术疗效的主要因素及手术适应证的选择.方法 回顾性分析1985年2月至2006年12月427例心脏瓣膜置换术的资料.427例中男196例,女231例;平均年龄(45±3)岁.风湿性瓣膜病403例(94.3%),非风湿性瓣膜病24例(5.7%).其中二尖瓣置换术302例,主动脉瓣置换术46例,主动脉辩与二尖瓣置换术65例,再次二尖瓣置换术14例;同期行三尖瓣成形术231例.结果 术后早期并发症46例(10.8%),手术死亡11例(2.58%).主要死亡原因为心力衰竭和多脏器功能衰竭.影响瓣膜置换术后早期疗效的主要危险因素是术前巨大左室,收缩功能减弱,心功能Ⅳ级,肾功能衰竭,严重感染,术后低心排综合征和多脏器功能衰竭.结论 合理选择手术时机,保留瓣下结构,积极纠正三尖瓣病变和心律失常,术中良好的心肌保护是提高手术疗效的关键.

abstractsObjective To summarize the experience of valve replacements and the operative indication. Methods The follow-up data of 427 patients were analyzed retrespectively between Feb. 1985 and Dec. 2006,196 males ,231 females, mean age was(45±3) years. Rheumatic valvular disease presented in 403 (94.3%)patients and non-rheumatic valvular disease in 24 patients (5.7%). 302 patients had mitral valve replacement (MVR), 46 had aortic valve replacement(AVR), 65 had MVR AVR, 14 had second MVR. Tricuspid valve annuloplasty in 231 patients. Results The early postoperative complication and mortality rote were 10.8% and 2. 58%. The major cause of early death was heart failure or multiple organ function failure. The main factors influencing the early surgical results were preoperative severe left ventricular enlargement and systolic dysfunction. Included leart function class Ⅳ(NYHA), renal failure, severe infection, postoperative low cardiac output and multiple organs function incompetence. Conclusion Timely decision of the operation for heart valve disease is very important. Subvalvular strac- ture preservation and tricuspid annuloplasty contribute and treatment arrhythmia can greatly improved heart function. Satisfactory myocardial protection during CPB is the key of successful operation.