中重度缺血性二尖瓣反流手术疗效的比较研究  

Comparative study on effect of surgery for moderate/severe ischemic mitral regurgitation

作　　者：尹博[1,2] 王晓龙[1,2] 刘愚勇[1,2] 郑铁[1,2] 贡鸣[1,2] 李海洋[1,2] 刘欧[1,2] 关欣亮[1,2] 彭小乐[1,2] 姜文剑[1,2] 黄琦[1,2] 郭冬[1,2] 张宏家[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科 [2]北京市心肺血管疾病研究所教育部心血管重塑相关疾病重点实验室北京市大血管疾病诊疗中心北京市大血管外科植入式人工材料工程技术研究中心,北京100029

出　　处：《首都医科大学学报》2015年第3期345-353,共9页Journal of Capital Medical University

基　　金：国家自然科学基金(81170283;81470580);北京市自然科学基金(7112041);教育部"新世纪优秀人才支持计划"(NCET-11-0899)~~

摘　　要：目的该研究主要比较二尖瓣修复术和二尖瓣置换术两种治疗方法对缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)的效果,确定二尖瓣手术方式的不同是否会对患者手术病死率、生存率、反流纠正效果及预后产生影响,探索哪种患者能够从二尖瓣修复术或二尖瓣置换术中获益。方法回顾分析首都医科大学附属北京安贞医院从2003年至2013年的296例患者,均为IMR,反流情况为中、重度,两组患者在体外循环、冠状动脉旁路移植术(coronary artery bypass grafting,CABG)基础上分别进行二尖瓣修复(mitral valve repair,MVP)和二尖瓣置换(mitral valve replacement,MVR),回顾患者基本资料、手术方式、术前及出院后心脏超声结果、围术期事件,对出院患者进行随访,观察长期生存率及心功能状况、再住院情况,采用统计学软件SPSS20.0对收集的数据信息进行分析。结果 1)两组患者在基线数据及手术情况方面差异无统计学意义;2)置换及修复组手术病死率差异无统计学意义(P=0.607);3)长期生存率:①随访中发现置换组有优于修复组的总体生存曲线(P<0.05);②在射血分数>30%的情况下,置换组较修复组生存率有优势(P<0.05);③在年龄>65岁的高龄组,置换组的生存率优于修复组(P<0.05);④在射血分数≤30%的情况下,置换组和修复组生存率差异无统计学意义(P>0.05);4)在术后情况中,重症加强护理病房(intensive care unit,ICU)停留时间、总住院天数和住院花费方面,修复组要优于置换组(P<0.05);5)在以心脏超声结果为反流纠正效果的衡量标准的比较中,对于反流的纠正的效果和纠正的完全率上,置换组优于修复组。6)在再住院率上,两组差异无统计学意义;7)术后随访存活患者心功能情况,两组差异无统计学意义。结论 1)对于反流的纠正效果,置换组优于修复组;2)两组手术病死率差异无统计学意义;置换组长期生存率总体要优于修复Objective This study aimed to compare effects of surgeries for mitral valve repair and replacement in patients with ischemic mitral regurgitation（IMR）,and to determine whether mitral valve operation in different ways will have an impact on patient mortality,survival rate and prognosis.Methods This study included a total of 296 patients,all had moderate to severe chronic ischemic mitral regurgitation.The patients were divided into two groups;on the basis of coronary artery bypass grafting,group 1 received mitral valve repair and group 2 received mitral valve replacement.The patients were followed up for the long term survival rate and heart function,readmission.Finally,the data were analyzed through statistical method.Results 1） No statistically significant differences in baseline data were found between the two groups of patients,and operation details;2） The operation mortality：No significant difference was found between mitral valve repair group and mitral replacement group（P = 0.607）;3） Long term survival curve：mitral valve replacement was better than mitral valve repair on the whole（P 〈 0.05）;survival rate of mitral valve replacement group patients was better than that of mitral valve repair group when left ventricular ejection fraction was over 30%（P 〈 0.05）;survival rate of patients received mitral valve replacement was better than that of patients received mitral valve repair when age was over 65 years（P 〈 0.05）;no significant difference was found between mitral valve replacement and mitral valve repair groups in survival rate when left ventricular ejection fraction was less than 30%（P 〉 0.05）.4） In the postoperative ICU,residence time,total hospital stay and cost were significantly better in mitral valve repair group.5） Echocardiography showed that regurgitation corrective effect was significantly better in mitral valve replacement group than that of the mitral valve repair group.6） In the rehospitalization rate,no statistically significant differences was fo

关 键 词：缺血性二尖瓣反流 冠状动脉旁路移植术 二尖瓣置换 二尖瓣修复 

分 类 号：R542.5[医药卫生—心血管疾病]