Yada I, Shimono T, Shimpo H, Tanaka K, Okabe M, Mizutani T, Kusagawa M
Department of Thoracic Surgery, Mie University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1988 Sep;89(9):1442-5.
The present study was designed to evaluate and determine the factors which affected the prognosis of the surgical patients with severe valvular diseases. Four hundred and forty six cases which underwent valvular surgery from 1977 to 1987 were used for this study. There were 16 early death cases (3.6%) and 16 late death cases (3.6%), respectively. The early death rate after surgery was significantly high in the cases which had 1) poor LV function (LVEF less than 35%), 2) liver dysfunction (T-Bil greater than 1.3mg/dl, ICG-Rmax less than 1.0 mg/kg/min, Ch-E less than 0.6PH, K-ICG 0.10/min), and/or 3) PVE after valve replacements. These factors were recognized in 9 (56.3%) of the early death cases and 10 (62.5%) of the late death cases. Thus, we consider that these factors affect the surgical prognosis and that the border line values for the factors are: 1) LVEF less than 0.3%, LVDI greater than 40 ml/m2 in MS group and 50 mg/m2 in other valvular groups. 2) T-Bil greater than 2.7 mg/dl, ICG-Rmax less than 0.5mg/kg/min in cardiac cachectic cases, and 3) active PVE cases which showed drug-resistance. Furthermore, these values should be corrected by IVH and immunosupportives during the pre- and post-operative periods.
本研究旨在评估并确定影响重症瓣膜病手术患者预后的因素。本研究采用了1977年至1987年间接受瓣膜手术的446例病例。早期死亡病例16例（3.6%），晚期死亡病例16例（3.6%）。在以下情况的病例中，术后早期死亡率显著较高：1）左心室功能差（左心室射血分数小于35%）；2）肝功能障碍（总胆红素大于1.3mg/dl，吲哚氰绿最大清除率小于1.0mg/kg/min，胆碱酯酶小于0.6PH，吲哚氰绿潴留指数0.10/min）；和/或3）瓣膜置换术后发生人工瓣膜心内膜炎。这些因素在9例（56.3%）早期死亡病例和10例（62.5%）晚期死亡病例中被发现。因此，我们认为这些因素影响手术预后，这些因素的临界值为：1）二尖瓣狭窄组左心室射血分数小于0.3%，左心室舒张末期内径大于40ml/m2，其他瓣膜组大于50mg/m2。2）心脏恶病质病例中总胆红素大于2.7mg/dl，吲哚氰绿最大清除率小于0.5mg/kg/min；3）表现为耐药的活动性人工瓣膜心内膜炎病例。此外，在术前和术后期间，这些值应通过静脉内高营养和免疫支持进行校正。
