50岁以上继发房缺患者外科治疗.docVIP

50岁以上继发房缺患者外科治疗 　【关键词】 继发房 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 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. Key words：Secundum atrial septal defect；Cardiac surgical procedures 1990年3月至2003年4月，我们共收治50岁以上ASD病人32例，现将详细结果报告如下： 1资料与方法 1.1一般资料：本组32例中男13例，女19例；年龄50～63岁，均于胸骨左2、3肋间可及2～3级收缩期杂音，P2增强，心功能（NYHA）Ⅱ级20例、Ⅲ级10例、Ⅳ级2例，中