頁籤選單縮合
題 名 | Results of Cardiac Valve Replacement with Porcine Xenograft--A Comparison with Mechanic Prosthesis=豬心瓣膜置換結果--並與機械性人工心瓣膜之比較 |
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作 者 | 朱樹勳; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 13:3 1980.09[民69.09] |
頁 次 | 頁171-182 |
關鍵詞 | 豬心瓣膜置換; 機械性人工心瓣膜; |
語 文 | 英文(English) |
中文摘要 | 從民國65年4月起67年12月之期間,共有365病人在臺大醫院接受心瓣膜置換。依據所用心瓣膜之種類而將病人分成三組。第一組共有234病人接受267個豬心瓣膜置換。第二組共有114病人接受136個機械性人工心瓣膜。第三組共有8個病人,每人接受2個或33個心瓣膜置換,其中主動脈瓣膜使用機械性人工瓣膜,僧帽瓣及三尖瓣使用豬心瓣膜。 第一組病人手術後早期死亡率為8.6%,晚期死亡率為5.1%。晚期死亡病人當中,36.4%與所用瓣膜有關。13位病人於手術後發生菌血症(5.6%),而導致8人死亡。手術後9人發生血栓症,4人因而死亡。 第二組病人之手術後早期死亡率為10.5%,晚期死亡率為12.7%。69.3%之晚期死亡病人與所用瓣膜有關。手術後3人(2.6%)發生菌血症,而全部死亡。2人有早期血栓症,而晚期血栓症則有3人。 第三組之8位病人手術全部成功,而在追踪複查期間無任何合併症。 本研究得到下列結論: 1.心瓣膜置換手術之早期死亡率與心肌衰竭及心室不整律有關,而與所使用之心瓣膜無關。 2.手術後晚期之罹病率及死亡率視所使用之心瓣膜而定,以使用豬心瓣膜較低。 3.豬心瓣膜置換後必須使用抗凝血劑兩個月。 4.使用豬心瓣膜病人於手術兩個月後,不必再使用抗凝血藥,卽使病人有慢性心房顫動,血栓症,手術當中發現左心房有血栓或左心房巨大者亦然。 5.手術後之菌血症發生率,豬心瓣膜較機械性人工瓣膜為高。然換豬心瓣膜的病人,其菌血症較換人工心瓣膜者容易洽癒。 6.由於換豬心瓣膜之晚期罹病率與死亡率較低,不必長期服用抗凝血藥,且大部份豬心瓣膜皆有十年以上之堅韌度,因而有理由繼續使用豬心瓣膜。 7.在手術當中,設法保護心肌機能,同時儘量完全置換或矯正病變之心瓣膜為肪止手術後感染及血栓症之要點。 8.本文3年之臨床研究,顯示豬心瓣膜較機械性人工瓣膜優良。 |
英文摘要 | During the period between April 1976 and December 1978, a total of 356 patients underwent cardiac valve replacements at the National Taiwan University Hospital (NTUH). The patients were divided into 3 groups according to the prosthetic valves used. Group 1 comprised 234 patients who received 267 porcine xenografts. Group 2 had 114 cases implanted with 136 mechanic valves. Group 3 had 8 patients who had multiple valve replacements with both porcine xenografts and mechanic valves. The follow-up period was 32 months. Group 1 patients had an early mortality rate of 8.6% and a late mortality of 5.1%. Among the causes of late death, 36.4% was prosthetic valve-related. Bacteremia occurred in 13 cases (5.6%) during the immediate postoperative period, and 8 cases died of this complication. Postoperative thromboembolism occurred in 9 patients (3.8%), with mortality in 4 cases. Group 2 patients had an early mortality rate of 10.5% and a late mortality rate of 12.7%. Among the cases of late death, 69.3% was valverelated. Bacteremia immediately after surgery occurred in 3 patients (2.6%) and all died. Two patients had early cerebral embolization and 3 had late embolization. All 8 patients in group 3 survived operation and did not have any complication during the time of follow-up. The present study gave the following conclusions: 1.The early mortality rate of cardiac valve replacement is mainly related to myocardial failure and ventricular dysrhythmia, regardless of the prosthesis used, if the effective valve orifice area is adequate. 2. The late morbidity rate and mortality rate depend on the prosthesis used, being less in porcine valve. 3. After porcine valve replacement, anticoagulant therapy for 2 months is mandatory. 4. Anticoagulant therapy is not necessary beyond 2 months even the patient has chronic atrial fibrillation, history of thromboembolism, left atrial (LA) thrombus found during surgery, and huge LA. 5. The incidence of bacteremia is higher in porcine valve than mechanic valve. However the bacteremia is more easily eradicated in patients with xenograft than mechanic valve. 6. The low incidence of late mortality and morbidity without anticoagulant therpay andththe prospect for an in vivo durability of 10 years or more in most patients justify for continuous use of the glutaraldehyde-preserved porcine xenograft as cardiac valve substitute. 7. Prevent the postoperative low eardiac output syndrome by myocardial protection during surgery and replace or correct the diseased valve or valves as completely as possible are mandatory to decrease the incidence of postoperative infection and thromboembolism. 8. The 3 year clinical investigation of the present series revealed that porcine xenograft has a better result than mechanic valve. |
本系統中英文摘要資訊取自各篇刊載內容。