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目的评价儿童瓣膜置换术同术期及中长期疗效,探讨儿童瓣膜置换术适应证,分析术后抗凝特点及避免或减缓再次手术的方法。方法回顾性分析1991年12月至2006年8月,113例患儿128枚瓣膜置换术围术期疗效及中长期随访结果。结果住院死亡5例(4.4%),其中3例死于低心排综合征,1例死于心律失常,1例死于多器官衰竭。晚期死亡7例(6.5%),其中3例死于抗凝相关并发症。23例生物瓣膜置换患儿中有4例患儿需要行再次手术换瓣,随访的75例机械瓣置换患儿中有8例出现抗凝相关并发症。结论在严格掌握手术适应证的基础上,儿童人工心脏瓣膜置换术有较好的早期及中长期效果,但应尽量置入较大型号的瓣膜并选用相应的手术技巧,以保障儿童的成长,以避免或延缓再次手术,抗凝并发症是儿童瓣膜置换术后应该重视的问题。
Objective To evaluate the curative effect of valve replacement in children with the same period and in the medium and long term. To explore the indications of valve replacement in children and to analyze the characteristics of postoperative anticoagulation and to avoid or slow the reoperation. Methods A retrospective analysis was performed on the perioperative efficacy and long-term follow-up results of 128 valve replacement procedures in 113 children from December 1991 to August 2006. Results There were 5 hospitalizations (4.4%), of which 3 died of low cardiac output syndrome, 1 died of arrhythmia and 1 died of multiple organ failure. Seven patients died of advanced stage (6.5%), of which 3 died of anticoagulation-related complications. In 23 children with bioprosthetic valve replacement, 4 patients underwent reoperation for valve replacement. A total of 75 patients with mechanical valve replacement during follow-up showed anticoagulation-related complications. Conclusion On the basis of strict indications of surgical indications, children with artificial heart valve replacement have good early and long-term results, but should be placed into a larger model of the valve and the appropriate surgical techniques to protect children’s growth, To avoid or delay reoperation, anticoagulant complications should be paid attention to after valve replacement in children.