25 例急診心臟瓣膜置換術的臨床分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

劉帥 ,  任崇雷 , 姜勝利 , 王嶸 , 肖蒼松 , 王瑤 , 龔志云 , 高長青

中國人民解放軍總醫院心血管外科（北京 100853）;

Corresponding?author：

任崇雷, Email: renchonglei301@163.com

Keywords：

心臟瓣膜; 急診手術; 危重; 心功能不全

DOI：

10.7507/1007-4848.201810018

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目的總結急診心臟瓣膜置換治療危重心臟瓣膜病患者的臨床經驗。方法回顧性分析 2008 年 4 月至 2018 年 4 月內科藥物治療無效的接受急診手術治療 25 例重癥瓣膜病患者的臨床資料（除外主動脈夾層、急診搭橋同期行瓣膜手術及心臟腫物累及瓣膜手術的病例）。其中男 14 例、女 11 例，平均年齡（45.0±14.6）歲。均合并嚴重的心功能不全（Ⅳ級），8 例術前需要機械通氣。感染性心內膜炎 11 例，均可見明顯贅生物，其中 4 例合并瓣周膿腫；瓣膜重度狹窄 8 例，急性瓣膜重度關閉不全 6 例，包括急性腱索斷裂 4 例、二尖瓣成形術后失敗再次急診行置換術 2 例。所有患者均在急診、全身麻醉、體外循環下行瓣膜置換術。結果所有 25 例患者手術后住院期間死亡 6 例（24.0%），其中 5 例死于多臟器功能衰竭，1 例死于感染復發導致的敗血癥。另有 1 例術中出現Ⅲ度房室傳導阻滯安裝永久性起搏器；2 例術后早期出現腦出血，經積極治療后康復，其余均順利出院。隨訪 1～120 個月，隨訪率 100%（19/19），1 例術后 3 個月出現肺部感染死亡，其余患者的心功能均改善明顯（Ⅰ級 3 例，Ⅱ級 15 例）。結論手術指征明確的重癥瓣膜患者在內科藥物治療無效時應積極選擇急診手術治療，不僅能夠挽救患者的生命，還能提高患者遠期生存質量。

Citation： 劉帥, 任崇雷, 姜勝利, 王嶸, 肖蒼松, 王瑤, 龔志云, 高長青. 25 例急診心臟瓣膜置換術的臨床分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(8): 822-825. doi: 10.7507/1007-4848.201810018 Copy

1.	McGoon WC. Cardiac Surgery. Philadelphia: F A Davis Company, 1987, 163.
2.	任崇雷, 姜勝利, 李伯君, 等. 感染性心內膜炎合并主動脈瓣周膿腫的外科治療. 中華外科雜志, 2014, 52(4): 263-266.
3.	朱家麟. 關于危重心臟瓣膜病標準的探討. 中華外科雜志, 1994, 32(6): 323-324.
4.	辛軍, 王厚強, 陸軍, 等. 高危患者心臟瓣膜置換手術的臨床經驗. 中國心血管病研究雜志, 2005, 3(8): 603-605.
5.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
6.	Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
7.	García-Cabrera E, Fernández-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation, 2013, 127(23): 2272-2284.
8.	Liang F, Song B, Liu R, et al. Optimal timing for early surgery in infective endocarditis: a meta-analysis. Interact Cardiovasc Thorac Surg, 2016, 22(3): 336-345.
9.	Anantha Narayanan M, Mahfood Haddad T, Kalil AC, et al. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Heart, 2016, 102(12): 950-957.
10.	Jia L, Wang Z, Fu Q, et al. Could early surgery get beneficial in adult patients with active native infective endocarditis? A meta-analysis. Biomed Res Int, 2017, 2017: 345-468.
11.	Akins CW, Travis B, Yoganathan AP. Energy loss for evaluating heart valve performance. J Thorac Cardiovasc Surg, 2008, 136(4): 820-833.
12.	Okada K, Okita Y. Surgical treatment for aortic periannular abscess/pseudoaneurysm caused by infective endocarditis. Gen Thorac Cardiovasc Surg, 2013, 61(4): 175-181.
13.	López J, Sevilla T, Vilacosta I, et al. Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients. Rev Esp Cardiol (Engl Ed), 2013, 66(5): 384-390.
14.	Kiefer T, Park L, Tribouilloy C, et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA, 2011, 306(20): 2239-2247.
15.	Thuny F, Beurtheret S, Mancini J, et al. The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis. Eur Heart J, 2011, 32(16): 2027-2033.
16.	Lytle BW, Priest BP, Taylor PC, et al. Surgical treatment of prosthetic value endocarditis. Thorac Cardiovasc Surg, 1996, 111(3): 198-210.

1. McGoon WC. Cardiac Surgery. Philadelphia: F A Davis Company, 1987, 163.
2. 任崇雷, 姜勝利, 李伯君, 等. 感染性心內膜炎合并主動脈瓣周膿腫的外科治療. 中華外科雜志, 2014, 52(4): 263-266.
3. 朱家麟. 關于危重心臟瓣膜病標準的探討. 中華外科雜志, 1994, 32(6): 323-324.
4. 辛軍, 王厚強, 陸軍, 等. 高危患者心臟瓣膜置換手術的臨床經驗. 中國心血管病研究雜志, 2005, 3(8): 603-605.
5. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
6. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
7. García-Cabrera E, Fernández-Hidalgo N, Almirante B, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation, 2013, 127(23): 2272-2284.
8. Liang F, Song B, Liu R, et al. Optimal timing for early surgery in infective endocarditis: a meta-analysis. Interact Cardiovasc Thorac Surg, 2016, 22(3): 336-345.
9. Anantha Narayanan M, Mahfood Haddad T, Kalil AC, et al. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Heart, 2016, 102(12): 950-957.
10. Jia L, Wang Z, Fu Q, et al. Could early surgery get beneficial in adult patients with active native infective endocarditis? A meta-analysis. Biomed Res Int, 2017, 2017: 345-468.
11. Akins CW, Travis B, Yoganathan AP. Energy loss for evaluating heart valve performance. J Thorac Cardiovasc Surg, 2008, 136(4): 820-833.
12. Okada K, Okita Y. Surgical treatment for aortic periannular abscess/pseudoaneurysm caused by infective endocarditis. Gen Thorac Cardiovasc Surg, 2013, 61(4): 175-181.
13. López J, Sevilla T, Vilacosta I, et al. Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients. Rev Esp Cardiol (Engl Ed), 2013, 66(5): 384-390.
14. Kiefer T, Park L, Tribouilloy C, et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA, 2011, 306(20): 2239-2247.
15. Thuny F, Beurtheret S, Mancini J, et al. The timing of surgery influences mortality and morbidity in adults with severe complicated infective endocarditis: a propensity analysis. Eur Heart J, 2011, 32(16): 2027-2033.
16. Lytle BW, Priest BP, Taylor PC, et al. Surgical treatment of prosthetic value endocarditis. Thorac Cardiovasc Surg, 1996, 111(3): 198-210.

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25 例急診心臟瓣膜置換術的臨床分析

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