褥式与褥式外翻缝合法行主动脉瓣置换的临床对比  

A clinical comparative study on mattress suture and everting mattress suture in aortic valve replacement

作　　者：谢建将[1] 黄达德[1] 区景松[1] 罗兆榴[1] 陈文广[1] 陈伟民[1] 张春曦[1] 吕德雄[1] 

机构地区：[1]广州医学院附属广州市第一人民医院心胸外科,广州市临床医学研究所,广东广州510180

出　　处：《中国现代医学杂志》2009年第22期3496-3499,共4页China Journal of Modern Medicine

摘　　要：目的分析比较间断褥式与褥式外翻缝合法行主动脉瓣置换(AVR)术后主动脉瓣有效瓣口面积、跨瓣压差、心功能的变化以及相关并发症的发生情况,探讨两种不同缝合方法的优缺点。方法随机选取63例行AVR的患者为研究对象,其中34例行间断带垫片褥式缝合,29例行间断带垫片褥式外翻缝合。术后临床随访观察患者主动脉瓣有效瓣口面积,以及跨瓣压差、心功能的变化和相关并发症的发生情况,随访时间4～81个月,平均(37.23±15.79)月。结果术后1例因无法复跳、1例因主动脉切口出血而早期死亡,1例术后5个月出现脑出血,全组病人术后无脑血栓及瓣周漏发生。2组患者相对比,术前一般资料及术后并发症(包括出血、血栓形成、瓣周漏和冠脉开口受影响等)无显著差异(P>0.05),褥式缝合组术后有效瓣口面积比褥式外翻组高(P<0.05)、主动脉跨瓣压差较后者低(P<0.05)、术后左室射血分数(LVEF)比后者高(P<0.05)、主动脉阻断时间较后者缩短(P<0.05)。结论在AVR手术中用褥式缝合法较褥式外翻法可以增大主动脉瓣有效瓣口面积、降低主动脉跨瓣压差、缩短主动脉阻断时间、有利于手术后左心功能的恢复,而相关并发症与褥式外翻组无显著性差异。[ Objective ] To study advantage and disadvantage between interrupt mattress suture and everting mattress suture in aortic valve replacement （AVR）, we compared AVR postoperative gradients of aortic valve, effective orifice area （EOA） of aortic valve, change of heart function and the incidence of correlated complications between these two methods. [Methods] 63 patients were selected randomly in this study. 34 patients received AVR via mattress suture and 29 patients received AVR with everting mattress suture. The postoperative gradients, EOA of aortic valve, change of heart function and the incidence of correlated complications were compared between these two groups with foLlowing-up 4-81 months [mean（37.23±15.79）months]. [ Results ] 1 patient died for heart rebeat failure, and another patient died for bleeding of the cut of aorta in earlier period postoperatively.1 patient had hematencephalon in 5 month postoperatively. All patients have no cerebral thrombosis or parabasilar leak. Comparison of these two groups, preoperative patients general information and the incidence of correlated complications including bleeding, thrombogenesis, parabasilar leak, effect of the opening of coronary artery have no significant difference （P 〉0.05）, but patients received mattress suture had considerably larger EOA of aortic valve （P 〈0.05）, lower postopera- tive gradients of aortic valve （P〈0.05）, higher left ventricle ejection fraction postoperatively （P 〈0.05） and shorter du-ration of aortic cross-clamp in operation （P〈0.05）. [ Conclusion ] compared interrupt mattress suture with everting mattress suture in AVR, the mattress suture can enlarge EOA of aortic valve.reduce postoperative gradients of aortic valve, decrease the duration of aortic cross-clamp, be benefit for the recovery of postoperative left ventricle function, and the incidence of correlated complications have no significant difference.

关 键 词：主动脉瓣置换褥式褥式外翻手术 

分 类 号：R654.2[医药卫生—外科学]