无或伴有轻度主动脉瓣反流患者二尖瓣置换术后远期分析  

Long-term Observation of the Patients after Mitral Valve Replacement with or without Mild Aortic Valve Regurgitation

作　　者：荣昊[1] 肖锡俊[1] 魏东明[1] 向波[1] 常超[1] 蒋露[1] 

机构地区：[1]四川大学华西医院心脏外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2010年第2期127-130,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的观察术前无或伴有轻度主动脉瓣反流(aortic valve regurgitation,AR)患者施行二尖瓣置换术后的远期结果,探讨二尖瓣置换术时是否需要同期处理所伴有的轻度AR。方法将1999年3月至2004年4月在四川大学华西医院行二尖瓣置换术(术前无或伴轻度AR)并随访5年或5年以上的88例患者纳入研究,按其术前超声心动图检查是否无或伴有轻度AR将患者分为两组,AR组:伴有轻度AR,35例,男7例,女28例;年龄49.26±11.87岁;术前心功能分级(NYHA):Ⅱ级4例,Ⅲ级26例,Ⅳ级5例。无AR组:无AR,53例,男7例,女46例;年龄48.59±10.22岁;术前NYHA:Ⅱ级7例,Ⅲ级39例,Ⅳ级7例。术后定期随访,术后5年完成超声心动图复查。结果术后随访时间5～9年(6.39±1.26年),两组患者性别、年龄、术前NYHA、心律等比较差异无统计学意义(P=0.394,0.841,0.960,0.732)。AR组患者术后NYHA构成、左心室射血分数(LVEF)和左心室缩短分数(LVFS)均较术前明显改善及增加(P<0.05);无AR组患者术后NYHA构成及LVEF亦较术前明显改善及增加(P<0.05),而术前、术后的LVFS比较差异无统计学意义(P>0.05)。两组患者术前、术后左室径(LV)、主动脉内径(AO)比较差异无统计学意义(P>0.05);AR组术前、术后发生AR的例数比较差异无统计学意义(P>0.05),而无AR组患者术前、术后发生AR的例数差异有统计学意义(P<0.05)。结论术后5～9年术前伴有轻度AR的二尖瓣置换术患者术前、术后AR构成变化不明显,对二尖瓣置换术患者不需要同期预防性处理所伴有的轻度AR。Objective To observe the long-term condition of patients after mitral valve replacement with or without mild aortic valve regurgitation（AR） and discuss whether treatment of AR is necessary during the course of mitral valve replacement.Methods From March 1999 to April 2004,88 patients who underwent mitral valve replacement（with or without mild AR before surgery） in West China Hospital of Sichuan University were followed up for 5 years or more.The patients were divided into two groups according to whether they had mild AR based on the result of preoperative echocardiography examination.In the AR group,there were 35 patients including 7 males and 28 females aged 49.26±11.87.By the New York Heart Association（NYHA） grading system before surgery,4 patients were classified as ClassⅡ,26 ClassⅢand 5 ClassⅣ.In the non-AR group,there were 53 patients including 7 males and 46 females aged 48.59±10.22.Using the NYHA grading system before surgery,we found there were 7 patients with ClassⅡcardiac function,39 ClassⅢand 7 ClassⅣ.After operation,all patients were followed up regularly and 5 years after surgery,patients were examined by echocardiography again.Results The follow-up period ranged from 5 to 9 years（6.39±1.26）.There was no statistical difference in gender（P= 0.394）,age（P= 0.841）,preoperative cardiac function（P= 0.960） and cardiac rhythm（P= 0.732） between the two groups.For the AR group,after operation,NYHA heart function,left ventricle ejection fraction（LVEF） and left ventricle fraction shortening（LVFS） significantly increased or improved（P 0.05）.In the non-AR group,after operation,NYHA heart function and LVEF significantly improved（P0.05）,while LVFS had no significant change（P0.05）.Left ventricular dimensions（LVD） and aortic dimensions between the two groups had no significant difference after

关 键 词：风湿性心脏病 二尖瓣置换术 主动脉瓣反流 

分 类 号：R654.2[医药卫生—外科学]