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50岁以上继发房缺患者的外科治疗
http://www.100md.com 《河北医学杂志》 2005年第4期
继发房,,房缺;心脏手术,1资料与方法,2结果,3讨论,参考文献:
     摘要:目的:总结50岁以上继发房缺病人手术治疗经验及其疗效。方法:选择1990年3月至2003年4月,50岁以上继发房缺接受手术治疗病人32例,年龄:50~64岁,平均54±3.5岁。其中合并三尖瓣中重度返流18例、二尖瓣关闭不全8例、房颤6例、冠心病2例;肺动脉平均压力49.08±8.52,最高65mmHg;心功能三级10例、四级2例,采用心包补片或涤纶补片补缺损,同期行三尖瓣成形18例、二尖瓣成形术6例、二尖瓣置换术2例、右房迷宫术2例、冠状动脉搭桥术2例。结果:31例成功、1例死亡,死亡原因是肺动脉高压、严重低心排综合症。术后心包积液、心律失常、肺部感染等13例(40.6%),随访(2个月—13年)、术后复查右心负荷明显改善、右心缩小、肺动脉高压改善明显或消失,心功能Ⅱ级以上。结论:高龄房缺术后并发症发生率高,但外科治疗近远期疗效良好,术前应行心导管检查、冠脉造影,合并症准确合理的治疗是手术成功及预后的关键。

    关键词:房缺;心脏手术

    Surgical Treatment of Isolated Secundum Artrial Septal Defect in Patients Above 50 years old

    LI Jin-lai

    (Zaozhuang Hospital, Shandong Zaozhuang 277102, China)

    Abstract: Objective:To evaluate the results of surgical treatment of isolated secundumartrial septal defect(ASD)in elder patients. Method: From Mar. 1990 to Apr. 2003,32 patients over 50 years old (range 50~63) received surgical treatment.concomitant cardiac anomalys:tricuspid regurgitation in 18 patients,mitral valve regurgitation in 8,atrial tibrillation in 6,CAD in 2.preoperative ment pulmonary arterypressure Was(40.98±8.52)mmHg.All of the patients underwent Dacron or pericardia patch,18 TVR and 6 MVR,2MVP,2 patients with artrial fibrillation underwent right sided maze pricdure,and 2,CABG.Result:31 patients survied after surery,there were one death,the cause of death was low output syndrome.Hydrocatdia、Arrhychmia delayed hemorrhage in 13 patients were followed up from 2 months to 13years,the follow-up data recorded decreased load of right ventricle,the decreased diamter of right ventricle as well as the rilief of pulmonary artery hypertension,cardiac function were improved.Conclusion: The rate of complication in old aged ASD pations is large.The long term results were satisfactory.cardiaccapheirization,arteriography is necessary,proper surgical management of the co-existing cardiac anomalys is an important factor. ......

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