多中心二尖瓣关闭不全保留瓣下结构瓣膜置换术后中期心功能变化研究  

Multicenter mid-term follow-up study of cardiac function with valve replacement of chordal preservation in mitral insufficiency

作　　者：张万青 戚春梅 梁克 曹勇[3] 陈波[3] 刘培兰 陈如红 程可洛 陈雪松 ZHANG Wan-Qing;QI Chun-Mei;HANG Ke;CAO Yong;CHEN Bo;LIU Pei-Lan;CHEN Ru-hong;CHENG Ke-luo;CHEN Xue-song(Department of Thoracic Cardiovascular Surgery,the Affiliated Hospital of GuangDong Medical University,Zhanfiang 524001,Guangdong,CHINA;Department of Pharmacy,the Second Affiliated Hospital of Guangdong Medical University,Zhanjiang 524003,Guangdong,CHINA;Department of Cardiovascular Surgery,the People's Hospital of GaoZhou City,GaoZhou 525200,Guangdong,CHINA;Department of Outpatient,Guangdong Medical University.Zhanjian 524023,Guangdong,CHINA;Department of Echocardiography,the Affiliated Hospital of Guangdong Medical University,Zhanjiang 524001,Guangdong,CHINA)

机构地区：[1]广东医科大学附属医院胸心外科,广东湛江524001 [2]广东医科大学第二附属医院药剂科,广东湛江524003 [3]高州市人民医院心脏外科,广东高州525200 [4]广东医科大学门诊部,广东湛江524023 [5]广东医科大学附属医院超声科,广东湛江524001

出　　处：《海南医学》2018年第22期3190-3193,共4页Hainan Medical Journal

基　　金：广东省科技项目基金(编号:2012B061700039)

摘　　要：目的研究保留二尖瓣瓣下结构瓣膜置换术对患者中期心功能的恢复影响,为临床广泛开展该术式提供理论依据。方法选择2013年1月至2015年8月在高州市人民医院及2009年1月至2015年8月在广东医科大学附属医院因二尖瓣关闭不全为主要病变合并或不合并主动脉瓣疾病行保留二尖瓣瓣下结构二尖瓣膜置换术、二尖瓣及主动脉瓣双瓣置换术患者83例,收集患者出院后6个月以上回手术医院行彩色多普勒超声心动图复查的患者资料。平均随访时间(22.94±16.20)个月。其中保留全瓣瓣下结构9例(组1),保留后瓣瓣下结构42例(组2),二尖瓣及瓣下腱索全切32例(组3)。各组均应用双叶机械瓣。测定患者左房舒张期末前后径、左室舒张期末横径、左室射血分数、左室短轴缩短率;同时测定左室流入道及流出道、各瓣膜功能、瓣周情况。结果组1、组3、组2患者左房舒张期末前后径分别为(38.11±7.27) mm、(39.39±7.13) mm、(42.47±8.82) mm,左室舒张末横径分别为(44.00±6.18) mm,(44.54±7.01) mm,(45.93±6.69) mm,左室射血分数分别为(59.00±3.87) mm、(58.70±8.16) mm、(57.86±9.72) mm,左室短轴缩短率分别为(31.00±4.12)%、(30.58±6.70)%、(28.25±10.43)%,以上各项指标比较差异均无统计学意义(P>0.05);所有患者无左室流入道及流出道梗阻,无瓣周漏,人工机械瓣膜启闭良好。结论对二尖瓣关闭不全为主病变或同时合并主动脉瓣病变行二尖瓣置换或双瓣膜置换术患者进行中期随访,虽然各项指标无明显差异,但数据表明保留全瓣及瓣下结构较保留后瓣及瓣下结构及全切对中期心功能恢复帮助更明显。术中应用双叶机械瓣,术中精心操作,术后不会导致左室流入道及流出道梗阻、瓣膜功能障碍。Objective To study the impact of subvalvular preservation techniques in isolated mitral insufficiency patients and mixed mitral insufficiency patients with or without aortic valve disease,and to provide a theoretical basis for extensive clinical practice.Methods A total of 83patients undergoing mitral replacement or double valvular replcement because of mixed mitral regurgitation with or without aortic valvular disease,who admitted to the People's Hospital of Gaozhou City between January 2013and August 2015and the Affiliated Hospital of Guangdong Medical University between January 2009and August 2015,were selected as the research subjects.The patients were estimated by echocardiography 6 months after discharge from hospital.Among the 83patients,9 had total chordal preservation (group 1), 42had the preservation of the posterior leaflet (group 2),and 32had complete resection of the subvalvular apparatus (group 3).Echocardiography was performed to evaluate left atrial end-diastolic diameter (LADD),left ventricular end-diastolic diameter (LVDD),left ventricular ejection fraction (LVEF),left ventricular fractional shortening (FS).The data was analyzed with SPSS19.0 statistical package.The left ventrical inflow and outflow tract were estimated,and the prosthetic valve and paravalvular situation also were studied by echocardiography.Results The LADD of group 1,group 3 and group 2were (38.11±7.27)mm,(39.39±7.13)mm,(42.47±8.82)mm,respectively (P>0.05);the LVDD of group 1, group 3 and group 2 were (44.00±6.18)mm,(44.54±7.01)mm,(45.93±6.69)mm,respectively (P>0.05);the LVEF were (59.00±3.87)%,(58.70±8.16)%,(57.86±9.72)%,respectively (P>0.05);the FS were respectively (31.00±4.12)%,(30.58±6.70)%,(28.25±10.43)%,respectively (P>0.05).There were not obstruction of left ventricular inflow and outflow.The prosthetic valve function were good.There were no paravalvular leakage.Conclusion Although no statistic difference, the mid-term follow-up study showed that the total chordal preservation has better help for the cardia

关 键 词：心脏瓣膜病 二尖瓣关闭不全 瓣膜置换术 保留瓣下结构 随访研究 

分 类 号：R542.51[医药卫生—心血管疾病]