Appelbaum A, Kouchoukos N T, Blackstone E H, Kirklin J W
Am J Cardiol. 1976 Feb;37(2):201-9. doi: 10.1016/0002-9149(76)90313-1.
During 1972 and 1973, a total of 235 patients had open heart surgery for mitral valve disease unassociated with significant aortic or rheumatic tricuspid valve disease. Thirty-one underwent closed heart mitral commissurotomy, without mortality. Of the 204 patients undergoing open operation, 125 had sequential measurement of cardiac output and mixed venous oxygen pressure. The hospital mortality rate was 6.4 percent in the larger group of 204 patients and in the 125 with cardiac output measurements. The rate was greater in those with class IV disability (New York Heart Association criteria) preoperatively than in those with class III or II disability. The mean +/- standard deviation of the average cardiac index early postoperatively was 2.05 +/- 0.579 liters-min--1-m--2. Cardiac index was lower in the patients who died early postoperatively than in those who did not. The probability of hospital death was a significant function of cardiac index. The predicted probability of death was 10 percent with an average cardiac index of 1.42 liters-min--1-m--2 and increased sharply with lower indexes. Cardiac index was lower early postoperatively than preoperatively, and was lower in patients in class IV than in those in class III. There was no significant difference in cardiac index between patients with mitral valve replacement and those in repair. A history of closed commissurotomy, age, duration of cardiopulmonary bypass, duration of cardiac ischemia and method of myocardial preservation did not significantly influence cardiac index or hospital mortality rate. There was no significant relation between mixed venous oxygen pressure and hospital death. Further improvement in results of mitral valve surgery requires adequate preservation of left ventricular performance before, during and after operation.
在1972年至1973年期间，共有235例患者因二尖瓣疾病接受心脏直视手术，且未合并严重主动脉瓣或风湿性三尖瓣疾病。31例接受了闭式二尖瓣交界切开术，无死亡病例。在204例接受开放手术的患者中，125例连续测量了心输出量和混合静脉血氧分压。在204例患者的较大组以及125例有心输出量测量的患者中，医院死亡率为6.4%。术前纽约心脏协会标准为IV级残疾的患者死亡率高于III级或II级残疾的患者。术后早期平均心脏指数的平均值±标准差为2.05±0.579升·分钟⁻¹·米⁻²。术后早期死亡的患者心脏指数低于未死亡的患者。医院死亡概率是心脏指数的显著函数。平均心脏指数为1.42升·分钟⁻¹·米⁻²时，预测死亡概率为10%，且随着指数降低急剧增加。术后早期心脏指数低于术前，IV级患者的心脏指数低于III级患者。二尖瓣置换患者和修复患者的心脏指数无显著差异。闭式交界切开术史、年龄、体外循环时间、心肌缺血时间和心肌保护方法对心脏指数或医院死亡率无显著影响。混合静脉血氧分压与医院死亡之间无显著关系。二尖瓣手术结果的进一步改善需要在手术前、手术中和手术后充分保护左心室功能。
