心脏瓣膜术后血管内溶血的研究进展

发布时间：2018-10-15 09:30

【摘要】：血管内溶血是心脏瓣膜术后并发症之一。随着医学技术发展,严重瓣膜相关血管内溶血发生率显著降低,但亚临床溶血仍普遍存在。该并发症主要发生机制为瓣膜术后局部结构改变,导致非生理性血流形成,剪应力增高,引发红细胞破碎、血管性血友病因子减少,血小板功能异常。溶血的发生及严重程度受人工瓣膜、手术操作和原发病等多方面因素影响。早期主要原因为瓣膜设计缺陷和质量问题,现阶段以手术操作并发症所致为主。患者同时具有瓣膜功能异常和血管内溶血相关临床表现,治疗以纠正原发病为主,结合患者情况个体化用药,严重者考虑再次手术。近年来,介入下瓣膜置换术和瓣周漏修补术在世界范围内逐渐开展,相关研究及证据资料有限,值得进一步关注。
[Abstract]:Intravascular hemolysis is one of the complications after cardiac valve operation. With the development of medical technology, the incidence of severe valvular related intravascular hemolysis decreased significantly, but subclinical hemolysis was still prevalent. The main mechanism of this complication is that the local structure changes after valve operation, resulting in the formation of non-physiological blood flow, the increase of shear stress, the fragmentation of red blood cells, the decrease of von Willebrand factor, and the abnormal platelet function. The occurrence and severity of hemolysis are affected by prosthetic valves, surgical procedures and primary diseases. The main causes in the early stage were valve design defects and quality problems. Patients also have valve dysfunction and intravascular hemolysis related clinical manifestations, the main treatment is to correct the primary disease, combined with the individual use of patients, serious cases consider reoperation. In recent years, interventional valvular replacement and perivalvular leakage repair have been carried out all over the world.
【作者单位】：中国医学科学院北京协和医学院北京协和医院麻醉科;
【分类号】：R654.2

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