自体心脏瓣膜为无神经元控制，在多物理场因素引导下，血液流动场、瓣膜和腱索之间相互作用运动，保持血流单向流动。经临床研究表明，患者植入瓣膜后的瓣膜并发症及患者生存率，与瓣膜结构、血流流场密切相关，对此评价瓣膜的血流动力学性能对改进瓣膜结构具有重要作用。自制新型曲面双叶型机械瓣膜，通过理论解析和瞬态流固耦合模拟分析讨论瓣膜最大开启时瓣膜的血流动力学性能；并在体外动态仿真环境下，对曲面型双叶瓣膜进行血流动力学测试，采用Vivitest脉动流实验平台测量，通过测试瓣膜压力、开口面积、返流量等物理量来衡量瓣膜在主动脉位置的使用性能。最后研究同 St.Jude 双叶瓣和国内 GK瓣等同类机械瓣的动力学性能作对照，根据评价结果前瞻性地研究双叶曲面机械瓣结构性能。结果表明，研制的新型曲面瓣膜具有优良的血流动力学特性。

Heart valves which could provide unidirectional function of the blood are autologous valves without nerve control.Under the multi physics factors,the basic movements of the heat valves are directed by blood flow fields and the interaction of valve and tendons.In the clinical study,the patients''survival rate and the inci-dence of valvular complications all closely depend on the blood flow fields of the heart valve,thus the evaluation of the hemodynamics of the heart valves was critical important.In this paper,thought the theoretical analysis and transient fluid-structure interaction simulation hemodynamic performance of the valve;then tested the self-design curved bileaflet mechanical heart valves under the simulation of dynamic human body environment to measure the hemodynamic of the curved bileaflet heart valve.The utility of pulsating flow experiment makes the evaluation of the performance of artificial mechanical heart valve more effective.The valves''functions,such as va

目的：总结心脏瓣膜病机械瓣膜置换术后疗效，旨在评价心脏瓣膜置换手术的效果及手术后的中长期效果。方法选择本院2000年-2012年我院确诊的心脏瓣膜病患者300例，观察本组患者心脏瓣膜病机械瓣膜置换术后的临床疗效，术后并发症的原因以及发病例数。结果患者的手术之后心功能随访显示，患者心功能与血液动力学出现了很大的改善，并且，大部分患者的劳动能力得到了很大的改善，生活的质量出现了明显的提高。结论我院心脏瓣膜病机械瓣膜置换手术预后整体效果较好，手术的死亡率是可以接受的，和国内的比较并无明显的差别，大部分的患者在手术之后的心功能和生活的质量得到了明显的改善。

Objective To investigate the postoperative efficacy of mechanical valve replacement in the treatment of valvular heart disease and to evaluate the middle- and long-term outcomes of patients treated with heart valve replacement. Method A total of 300 patients diagnosed with valvular heart disease in our hospital from 2000 to 2012 were included in the study. The clinical efficacy of mechanical valve replacement, causes of postoperative complications, and number of cases of complications were evaluated. Results Postoperative follow-up of cardiac function showed that the treated patients showed substantial improvements in cardiac function and hemodynamics and that most patients had greatly increased ability to work and significantly improved quality of life (QOL). ConclusionOverall, the patients with valvular heart disease have good outcomes after mechanical valve replacement in our hospital, and the operative mortality is acceptable, with no significant difference compared with the nation

背景：应用机械瓣和生物瓣行瓣膜置换是治疗终末期瓣膜病的有效手段，然而他们的临床应用受到多个因素的限制。具备生物活性的组织工程心脏瓣膜有潜力克服机械瓣和生物瓣的不足，选择适宜的种子细胞是组织工程心脏瓣膜研究的一个重要方面，许多成熟的体细胞和干细胞已被用于构建组织工程心脏瓣膜，然而尚未获得理想的结果。 目的：以构成瓣膜的细胞成分为基础，对用于构建组织工程心脏瓣膜的种子细胞、体外细胞种植方法的研究进行综述。 方法：由第一作者基于PubMed数据库和万方数据库应用计算机检索2000年1月至2012年12月相关的文章，英文检索词为“Tissue engineering，Heart valves，Cel”，中文检索词为“组织工程，心脏瓣膜，细胞”，优选文章内容与组织工程心脏瓣膜种子细胞直接相关，具备针对性和权威性，发表在权威杂志的文章共39篇进行综述。 结果与结论：瓣膜的细胞成分主要是内皮细胞和间质细胞，早期人们常用内皮细胞和成纤维细胞构建组织工程瓣膜，随着干细胞研究的深入，应用搏动性生物反应器种植间充质干细胞具有构建的组织工程瓣膜的潜力。

BACKGROUND:Application of mechanical valve and bioprosthetic valve replacement is an effective means for the treatment of end-stage valve disease. However, their clinical application is constrained by multiple factors. Tissue-engineered heart valves with biological activity hold the potential to overcome the defect of the mechanical valves and bioprosthetic valves. Choosing appropriate cells for cellseeding is a significant aspect for the research of tissue-engineered heart valves. A growing number of somatic cells and stem cells have been used for construction of tissue-engineered heart valves, however, not yet achieve the desired result. OBJECTIVE:To review the studies on seed cells for tissue-engineered heart valves and the cellseeding methods in vitro on the basis of the cellular components of heart valves. METHODS:First author searched PubMed and Wanfang database with computer for related articles published from January 2000 to December 2012. The keywords were“tissue engineering,

目的介绍心脏瓣膜手术同期行冠状动脉旁路移植术的治疗体会。方法 2003年5月至2013年12月,心脏瓣膜手术同期行冠状动脉旁路移植术29例,患者男性13例,女性16例。年龄35~70岁。共搭桥54根。二尖瓣成形术8例;主动脉瓣机械瓣置换术3例;二尖瓣机械瓣置换术10例;主动脉瓣置换及二尖瓣成形术4例;双瓣膜置换术4例。结果术后早期死亡5例,病死率17.24%,其中左室破裂2例,多器官功能衰竭2例,室颤1例。随访3~24个月,心功能改善,无严重心绞痛发作。结论风湿性瓣膜病患者,有冠心病高危因素者,应常规行冠状动脉造影检查。缺血性二尖瓣关闭不全者如瓣膜成形效果差时,应选择保留瓣下结构的瓣膜置换术。

Objective?To?introduce?the?outcome??of??combined??valve??replacement??and???coronary??artery??bypass??grafting??in??patient??with??valvular?heart??disease??associated??coronary??heart??disease.?Methods?May?2003?to?December?2013,?heart?valve?surgery?over?the?same?period?coronary?artery?bypass?grafting?29?cases;?male?13?cases,?female?16?cases.?Age?35?to?70?years?old.?Total?bypass?54?root.?Results?5?cases?death?with?early?postoperative,?the?death?rate?was?17.24%,?Followed?up?for?3-16?months,?Patients?recovered?and?was?discharged?with??improved??heart??function.?Conclusion?Coronary?angiography?should be carried out routinely in patients with valvular heart disease, especially with coronary heart disease risk factors. Ischemic mitral insufifciency should choose?to?retain?disc?directly?under?the?structure?of?valve?replacement,?prevent?the?increased?mortality?and?postoperative?complications.

目的：建立连云港地区心脏机械瓣膜置换术后早期华法林抗凝模型。方法：收集我院2010年9月-2013年9月心脏机械瓣膜置换手术采用华法林抗凝的患者,随机分为两组,起始剂量3.75mg组（A组）和起始剂量5mg组（B组）,进行对比研究。比较两组抗凝起始剂量、维持剂量、抗凝强度、术后到达抗凝达标时间、抗凝稳定时间、术后抗凝并发症等。结果：A、B组抗凝模型均取得良好的抗凝结果;相比而言,B组模型比A组模型更有利于抗凝达标和稳定,抗凝并发症发生率比较无明显差别。结论：建立心脏机械瓣膜置换术后早期华法林抗凝模型,降低抗凝并发症发生率,从而降低医疗费用,改善患者长期生活质量。

Established early in Lianyungang warfarin model mechanical heart valve replacement surgery . Methods:Collected in our hospital in September 2010 to September 2013 mechanical heart valve replacement surgery pa-tients using warfarin were randomly divided into two groups ,the starting dose of 3 .75mg group (A) and the starting dose of 5mg group (group B) ,comparative study .Starting dose anticoagulation were compared ,the maintenance dose , anticoagulation intensity ,postoperative anticoagulation reach compliance time ,stable anticoagulation ,postoperative anti-coagulation complications .Results:A ,B group anticoagulant models have achieved good results anticoagulation;con-trast ,group B than in group A model anticoagulant standard model and more conducive to stable anticoagulation was no significant difference in the incidence of complications .Conclusion:A ,B group anticoagulant models have achieved good results anticoagulation;contrast ,group B than in group A model anticoagu