保留二尖瓣全瓣生物瓣替换术对左心功能的影响  

Influence of bioprosthetic mitral valve replacement with preservation of all valve on left cardiac function

作　　者：吴洪坤 杨庆军 陈灏 严宇 罗永金 余杨 喻鹏凌 Wu Hongkun Yang Qingjun Chen Hao Yan Yu Luo Yongjin Yu Yang Yu Pengling(Department of Cardiovascular Surgery, Chongqing General Hospita)

机构地区：[1]重庆市人民医院心血管外科,重庆400013

出　　处：《重庆医科大学学报》2016年第10期1079-1082,共4页Journal of Chongqing Medical University

基　　金：重庆市卫计委;重庆市医学科研计划资助项目(编号:2012-2-195)

摘　　要：目的:前瞻、对比、双盲的研究保留二尖瓣全瓣生物瓣替换术对左心功能的影响。方法:选取2012年5月至2014年2月到我院就诊的适合二尖瓣生物瓣替换术的患者共41例,随机分为2组:A组(实验组),术中保留二尖瓣全瓣及瓣下结构;B组(对照组),术中不保留二尖瓣瓣下结构。术前、术后10 d、术后6个月行超声心动图检查,评价左心功能。结果:病例无手术死亡,无左室破裂,无瓣膜功能障碍等严重并发症。A组发生1例术后食道超声提示左室流出道(left ventricular outflow tract,LVOT)梗阻及前叶前向运动。术后10 d经胸超声心动图,A组和B组在左室舒张末容积[left ventricular end diastolic diameter,LVEDD;A组:(52.8±7.1)mm,B组:(59.5±6.5)mm]、左室收缩末容积[left ventricular end systolic diameter,LVESD;A组:(43.7±6.1)mm,B组:(51.5±6.3)mm]、左室射血分数(left ventricular ejection fraction,LVEF;A组:(52.8±5.5)%,B组:(48.1±6.8)%均有明显差异,A组明显优于B组(P<0.05)。术后6个月经胸超声心动图,左室舒张末容积[A组:(49.9±6.5)mm,B组:(61.3±6.3)mm]、左室收缩末容积[A组:(37.6±4.0)mm,B组:(49.3±6.1)mm]、左室短轴缩短率(left ventricular fractional shortening,LVFS;A组:(39.9±4.9)%,B组:(31.2±3.7)%,A组明显优于B组(P<0.05)。结论:保留二尖瓣全瓣的生物瓣替换术,技术安全可行,术后6个月左心功能的改善明显优于不保留二尖瓣瓣下结构的二尖瓣生物瓣替换术。Objective：to evaluate the influence of bioprosthetic mitral valve replacement with preservation of all valve on left cardiac function. Methods：Totally 41 patients with mitral valve disease who underwent bioprosthetic mitral valve replacement were divided into 2 groups：A group（preservation of all valve,n =19）,B group（removal of all valve,n =22）. Color echocardiographic imaging was used preoperatively and postoperatively to measure the left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic diameter（LVESD）,left ventricular ejection fraction（LVEF）,left ventricular fractional shortening（LVFS）,left atrial diameter（LAD）.Then the results were compared. Results：No case of death,left ventricular rupture,bioprosthetic valve disfunction was observed. One case of left ventricular outflow tract（LVOT）was observed by transesophageal echocardiography（TEE）after operation. There was no significant difference between A and B group in LVEDD,LVESD,LVEF and LVFS before operation. There were significant differences between A and B group in LVEDD,LVESD,LVEF and LVFS measured on 10 days and 6 months after operation（P〈0.05）. Conclusion：The bioprosthetic mitral valve replacement with preservation of all valve is safe and effective;its positive effect on left heart function at 6 months after the operation is more obvious than mitral valve replacement without with preservation of all valve.

关 键 词：二尖瓣替换术 生物瓣 保留二尖瓣全瓣 左心功能 

分 类 号：R654[医药卫生—外科学]