老年患者保留后瓣及瓣下结构的二尖瓣置换术临床效果  

Clinical analysis of mitral valve replacement for the subvalvular preservation on the configuration and function of left ventricle in elderly patients

作　　者：蒙俊[1] 何建超[1] 陶杰[1] 李家宇[1] 杨堃[2] 

机构地区：[1]昆明医科大学第一附属医院心血管外科,云南昆明650032 [2]昆明医科大学第一附属医院麻醉科

出　　处：《中国老年学杂志》2016年第9期2101-2103,共3页Chinese Journal of Gerontology

基　　金：国家自然科学基金(No.81560320);云南省应用基础研究计划项目(昆医联合专项)(No.2014FB024)

摘　　要：目的探讨老年患者二尖瓣置换术保留后瓣及瓣下结构的临床效果。方法行二尖瓣置换术的老年患者135例,其中不保留后瓣及瓣下结构患者60例（对照组）,保留后瓣及瓣下结构患者75例（观察组）。分析比较两组患者手术后并发症、死亡率以及左心室大小与功能。结果观察组死亡率为1.3%,显著低于对照组的8.3%（χ^2=3.846,P〈0.05）。观察组出现二次开胸止血、低心排血量、脑卒中、肺部感染、心律失常、切口感染等并发症发生率为5.3%,显著低于对照组的16.7%（χ^2=4.606,P〈0.05）。对照组左心室破裂及低心排血量的发生率显著性高于观察组（χ^2=3.836、3.836,均P〈0.05）。术后3个月两组LVEDD、LVESD、LVEF均较术前显著改善（均P〈0.05）,但观察组术后3个月LVEDD、LVESD、LVEF改善情况显著性优于对照组（t=2.36、1.83、2.98,均P〈0.05）。结论保留后瓣及瓣下结构二尖瓣置换术方便、快捷,疗效确切,促进患者术后病情恢复,明显改善患者的心功能,且术后死亡率低、并发症发生率低,值得临床推广。Objective To discuss the clinical effects of mitral valve replacement（ MVR） for the subvalvular preservation on the configuration and function of left ventricle in patients above 60 years old. Methods 135 patients with MVR were retrospectively analyzed,including 60 cases of no-retained after the disc and disc structure as the control group and 70 cases of patients with retention after disc and disc structure as the observation group. Surgery complications,mortality,and left ventricular size and function of the two groups were recorded and compared. Results The mortality rate In of observation group（ 1. 3%） was significantly lower than that in control group（ 8. 3%,χ2= 3. 846,P 0. 05）. The incidence of complications of observation group（ 5. 3%） including secondary thoracotomy hemostatic,low cardiac output,stroke,lung infection,arrhythmia and infection of incision was significantly lower than that in the control group 16. 7%（ χ2= 4.606,P 0. 05）. In the control group the incidence of left ventricular rupture and low cardiac output was significantly higher than that in the observation group（ χ2= 3. 836,3. 836,P 0. 05）. After 3 months LVEDD,LVESD and LVEF in the two group were improved significantly（ all P 0. 05）,but in the observation group LVEDD,LVESD and LVEF were all improved more significantly（ all P 0. 05）. Conclusions Retaining after the disc and disc structure of mitral valve replacement is convenient and quick,which has exact curative effect,promotes the postoperative patient recovery,significantly improves the patient＇s heart function,which postoperative mortality and complication rate are lower,worthy of clinical promotion.

关 键 词：保留后瓣及瓣下结构 二尖瓣置换术 

分 类 号：R587.1[医药卫生—内分泌]