心脏瓣膜转换术后患者住院死亡原因分析

摘要

Objective: The aim of our study was to analyse the death cause and related factors of death in hospital of patients after cardiac valve replacement (CVR). Methods: Regression analysis of 34 patients' data was executed. Results: Death rate was 9.9 %, death cause: (1) L.ow cardiac output syndrome is the first complication and death cause (2.6 % ), which was closely related to cardiac function (grade Ⅳ ) before operation, LVEDD＞8.0 cm, LVEF＜0. 40, GR ＞80%, emergency operation, long time of arterial block, etc; (2) Ventricular tachycardia、 ventricular fibrillation is the second cause of death (2. 1%); (3) Respiratory failure (4) Post-operation hemorrhage inducing pericardial tamponade and shock; (5) Postoperation infection of replaced valve and brain complications. Conclusion: The success rate of operation can be increased by selecting patients strictly, improving operation methods, enhancing periopertive monitor.%目的：分析患者心脏瓣膜转换术后住院期死亡的原因和相关因素。方法：全组均在全麻低温体外循环(CPB)下行瓣膜置换术。结果：患者总死亡率9.9％，死亡原因：(1)低心输出量综合征是本组首位并发症和死因(2.6％)，它与术前心功能(Ⅳ级)，LXEDD＞8.0cm、LVEF＜0.4、CTR＞80％、急诊手术、心肌保护差、主动脉阻断时间长等密切相关；(2)术后室速、室颤是本组第二位死因(2.1％)，表现为突然发生，反复发作，十分顽固；(3)呼吸衰竭；(4)术后出血致心包填塞、休克；(5)术后移植瓣感染和脑部并发症。结论：严格选择病例，改进手术操作，加强围术期监测、抢救，有望提高手术成功率。