风湿性心脏病左心瓣膜置换同期三尖瓣成形术的效果分析  

Effect of left-sided cardiac valve replacement with tricuspid annuloplasty in patients with rheumatic heart disease

作　　者：付勇[1] 于风旭[1] 李新[1] 邓明彬[1] 廖斌[1] 

机构地区：[1]泸州医学院附属医院胸心外科,四川泸州646000

出　　处：《岭南心血管病杂志》2016年第3期262-264,282,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的回顾性分析风湿性心脏病(风心病)左心瓣膜置换同期行三尖瓣成形术患者的资料,探讨不同三尖瓣成形手术的临床疗效分析。方法 45例风心病二尖瓣、主动脉瓣病变患者行人工机械瓣置换术,同期行三尖瓣成形术,采用Kay法15例、De Vega法18例及成形环成形12例,术后1、3、6个月通过超声心动图、心电图、胸部X片随访观察,评估术后心功能、三尖瓣反流及心电生理等恢复情况。结果各组患者术前一般临床资料比较,差异无统计学意义(P>0.05)。术后心功能均较术前有改善,成形环成形术后三尖瓣反流较Kay法、De Vega法改善明显,Kay法和De Vega法组患者的三尖瓣反流比较,差异无统计学意义(P>0.05)。术后均未发生房室传导阻滞等缓慢性心律失常。有2例Kay法和1例De Vega法术后患者因心功能不全再次入院治疗,1例成形环成形术后心包积液行心包穿刺术治疗恢复。结论风心病左心瓣膜置换同期行三尖瓣成形术,术后心功能改善明显。成形环成形法较Kay法、De Vega法术后三尖瓣反流再发生率低,值得在三尖瓣反流的患者中推广应用。Objectives To review and analyze the effect of left-sided cardiac valve replacement with tricuspid annuloplasty in patients with rheumatic heart disease （RHD）, and to probe the clinical efficacy of various annuloplasty techniques. Methods Totally 45 patients with RHD were performed left-sided cardiac valve replacement with tricuspid annuloplasty, including 15 cases who underwent Kay＇s annuloplasty, 18 cases who underwent De Vega＇s annuloplasty and 12 cases who underwent ring annuloplasty. We observed and assessed the cardiac function, tricuspid regurgitation and cardiac electrophysiology 1 month, 3 months and 6 months postoperatively by echocardiography, electrocardiography （ECG） and chest X-ray. Results There were no differences in preoperative clinical data of all the cases. There was more obvious improvement in cardiac function in ring annuloplasty cases than those in Kay＇s annuloplasty and De Vega＇s annuloplasty cases, while no significant difference was observed between Kay＇s annuloplasty cases and De Vega＇s annuloplasty cases （P〉0.05）. Atrioventrieular block or slow arrhythmias did not occur in any cases. There were 2 Kay＇s annuloplasty cases and 1 De Vega＇s annuloplasty case re-admitted for cardiac insufficiency, 1 ring annuloplasty cases for postoperative pericardial effusion who was treated by pericardial puncture and recovered. Conclusions Left-sided cardiac valve replacement with tricuspid annuloplasty can significantly improve cardiac function in patients with RHD. Incidence of tricuspid regurgitation in ring annuloplasty cases is lower than those in Kay＇s annuloplasty cases and De Vega＇s annuloplasty cases. Ring annnloplasty is worth appling in patients with tricuspid regurgitation.

关 键 词：风湿性心脏病 三尖瓣成形 心脏瓣膜置换 

分 类 号：R654.2[医药卫生—外科学]