风湿性二尖瓣狭窄合并小左心室患者手术治疗的三年随访结果  

3 Years Post-operative Outcome in Patients With Rheumatic Mitral Valve Stenosis and Small Left Ventricle

作　　者：王霁阳[1] 宋怡[1] 杨旭[1] 杨眉[1] 张晓羽[1] 李翔[1] 马润伟[1] 

机构地区：[1]云南省第二人民医院心血管外科,昆明市650021

出　　处：《中国循环杂志》2016年第7期687-691,共5页Chinese Circulation Journal

摘　　要：目的:探讨风湿性二尖瓣狭窄(MS)合并小左心室患者围术期综合治疗后的3年的随访结果。方法:将风湿性MS伴重度肺动脉高压患者共计152例,根据患者左心室舒张末期容积指数(LVEDVI)将患者分为两组,LVEDVI值≤60 mm为小左心室组(n=67),LVEDVI值>60 mm为非小左心室组(n=85),比较两组患者围术期及随访后的临床指标。结果:同非小左心室组患者相比,入院时小左心室组的中心静脉压和肺动脉收缩压(SPAP)较高(均P>0.05),而左心室舒张期容积(LVEDV)、LVEDVI和右心室射血分数(RVEF)较低(均P>0.05)。入院时两组患者均有肝功能损伤,小左心室组肝功能各项指标(碱性磷酸酶除外)较非小左心室组患者高,保肝治疗后术前两组患者的肝功能均恢复正常。术后即刻监测SPAP,小左心室组的SPAP与非小左心室组比较[(67.3.1±23.4)mm Hg vs(61.3±26.9)mm Hg,1 mm Hg=0.133 k Pa],差异无统计学意义(P>0.05)。52例严重肺动脉高压患者吸入万他维治疗,关胸时两组患者中万他维吸入者较未吸入者SPAP均明显降低,且小左心室组较非小左心室组万他维吸入者的SPAP也降低(P均<0.05)。术后3年心功能,与非小左心室组比较,小左心室组的LVEDVI较低,SPAP较高。术后3年随访时,与术前比较,两组患者的LVEDVI、RVEF提高,纽约心脏协会(NYHA)心功能平均分级降低,6 min步行试验(6 MWT)的距离明显延长;与非小左心室组比较,小左心室组LVEDVI均较低,6MWT的距离均较短(均P<0.05)。术后随访(3.7±1.6)年发现,小左心室组患者的中位生存时间(63.6个月vs 73.2个月)明显短于非小左心室组(P<0.05);两组患者的死亡率(2.6%vs 2.0%)差别无统计学意义(均P>0.05)。结论:MS合并小左心室的患者术前心、肝功能较差,手术风险大;虽然经过围术期的护肝、吸入万他维降低肺动脉高压、手术治疗等处理,明显改善术后心、肝功能,但术后3年随访时小左心室组患者的中位生存时间仍明显Objective： To explore the peri-operative treatment and 3 years post-operative outcome in patients with rheumatic mitral valve stenosis and small left ventricle.Methods： A total of 152 patients with rheumatic mitral valve stenosis and severe pulmonary hypertension were studied. According to left ventricular end diastolic index（LVEDI） value, the patients were divided into 2 groups： Small left ventricle（Small） group, the patients with LVEDI value≤60 mm, n=67 and Non-small left ventricle（Non-small） group, the patients with LVEDI value〉60 mm, n=85. Peri-operative condition and follow-up parameters were compared between 2 groups.Results： Compared with Non-small group, Small group had increased pre-operative CVP, SPAP and decreased LVEDV, LVEDVI and RVEF at admission, all P〈0.05. All patients had liver damage at admission, the indexes（except alkaline phosphatase） were higher in Small group than Non-small group, and the function was recovered prior operation by proper treatment. The immediatepost-operative SPAP in Small group and Non-small group were（67.3.1±23.4） mmH g and（61.3±26.9） mmH g, P〉0.05. There were 52 severe pulmonary hypertension patients received iloprost inhalation, their SPAP was decreased than non-inhalation patients at incision closing; SPAP was lower in Small group inhalation patients than Non-small group inhalation patients, all P〉0.05. Postoperative LVEDVI was lower and SPAP was higher in Small group than Non-small group. At 3 years post-operation, LVEDVI, RVEF increased, NYHA classification decreased and 6MWT prolonged in both groups; while LVEDVI was lower and 6MWT was shorter in Small group than Non-small group, P〈0.05. The median survival time at（3.7±1.6） years post-operation was shorter in Small group than Non-small group, P〈0.05, while the mortality was similar between 2 groups（2.6% vs 2.0%）, P〉0.05.Conclusion： The patients with mitral valve stenosis and small left ventricle had the worse pre-operative condition and higher risk in surg

关 键 词：二尖瓣狭窄 高血压 肺性 小左心室 外科治疗 

分 类 号：R541[医药卫生—心血管疾病]