Matsuda H, Nakao M, Nohara H, Higami T, Mukohara N, Asada T, Ogawa K, Kawamura T
Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji.
Kyobu Geka. 1990 Mar;43(3):172-7, discussion 177-82.
Whether a giant left atrium in mitral valve disease itself prolongs postoperative respiratory care or does not is an important problem. We investigated it in 39 patients who underwent MVR without plication of the left atrium. A giant left atrium (GLA) was defined when CT-LA volume exceeded 300 ml by rapid sequential CT or left atrial diameter exceeded 60 mm by echocardiography. According to this criteria, the 39 patients were divided into two groups: 18 patients of GLA group and 21 of non-GLA group. Eight GLA (44%) and 11 non-GLA patients (52%) needed postoperative respiratory care with intratracheal intubation for more than 24 hours. Four GLA (22%) and 2 non-GLA patients (9.5%) needed reintubation. There was no significant difference between the two groups concerning the duration of postoperative respiratory care and the frequency of reintubation. The reintubated patients had three prominent preoperative clinical profiles, such as poor general condition, poor cardiac function and poor respiratory function. Consequently, it is concluded that in mitral valve disease with a GLA the prolongation of postoperative respiratory care is largely due to poor cardiac and respiratory function rather than to the compression to the bronchus by a GLA.
二尖瓣疾病中的巨大左心房本身是否会延长术后呼吸护理时间是一个重要问题。我们对39例未进行左心房折叠术的二尖瓣置换术患者进行了调查。通过快速序列CT测量，当CT左心房容积超过300 ml，或通过超声心动图测量左心房直径超过60 mm时，定义为巨大左心房（GLA）。根据该标准，39例患者分为两组：GLA组18例，非GLA组21例。8例GLA患者（44%）和11例非GLA患者（52%）术后需要气管插管呼吸护理超过24小时。4例GLA患者（22%）和2例非GLA患者（9.5%）需要再次插管。两组在术后呼吸护理持续时间和再次插管频率方面无显著差异。再次插管的患者术前有三个突出的临床特征，如一般状况差、心功能差和呼吸功能差。因此，得出结论，在伴有GLA的二尖瓣疾病中，术后呼吸护理时间延长主要是由于心脏和呼吸功能差，而不是由于GLA对支气管的压迫。
