生物瓣膜二尖瓣置换老年心脏瓣膜病患者血清炎性因子及血流动力学的变化  

Changes in serum inflammatory factors and hemodynamics of biological mitral valve replacement for elderly patients with cardiac valve disease

作　　者：张杨[1] 赵巧燕[1] 翟继卫[1] 厉菁[1] Zhang Yang;Zhao Qiaoyan;Zhai Jiwei;Li Jing(The 7th People’s Hospital of Zhengzhou,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州市第七人民医院,河南省郑州市450000

出　　处：《中国组织工程研究》2022年第10期1561-1565,共5页Chinese Journal of Tissue Engineering Research

基　　金：河南省医学科技攻关计划(LHGJ20191109),项目负责人:赵巧燕;河南省医学科技攻关计划(LHGJ20191112),项目负责人:厉菁。

摘　　要：背景:保留全瓣及瓣下结构的二尖瓣置换是治疗心脏瓣膜病的有效方法,其中人工瓣膜材料的选择起到至关重要的作用。目的:探讨生物瓣膜二尖瓣置换在老年心脏瓣膜病患者中的应用效果。方法:回顾性分析郑州市第七人民医院2017年5月至2019年4月收治的老年心脏瓣膜病二尖瓣置换患者96例的临床资料,根据患者病情及意愿分为生物组62例、机械组34例。生物组进行保留全瓣及瓣下结构的生物瓣膜二尖瓣置换,机械组进行保留全瓣及瓣下结构的机械瓣膜二尖瓣置换,比较两组心功能及临床疗效、血清炎性因子、血流动力学、并发症等指标。研究已获得郑州市第七人民医院伦理委员会批准(20170315)。结果与结论:①术后随访12个月,生物组心功能美国纽约心脏病协会分级Ⅰ级占71%、临床治疗成功率为77%,机械组心功能美国纽约心脏病协会分级Ⅰ级占47%、临床治疗成功率为53%,两组间心功能分级与临床治疗成功率比较差异有显著性意义(P<0.05);两组均未发生人工瓣膜结构性衰坏所致再次手术及死亡病例,生物组患者血栓栓塞、心内膜炎、瓣周漏的发生率均低于机械组(P<0.05)。②术后3 d,生物组患者血清白细胞介素6、肿瘤坏死因子α的质量浓度均低于机械组(P<0.05),血清白细胞介素10的质量浓度高于机械组(P<0.05)。③术后随访12个月,生物组患者的二尖瓣口E峰峰值速度、平均跨压差检测结果低于机械组(P<0.05),人工瓣有效瓣口面积检测结果大于机械组(P<0.05)。④结果表明,生物瓣膜二尖瓣置换有助于改善老年心脏瓣膜病患者心功能、提高手术成功率、降低并发症,可能与拮抗炎症应激反应、改善血流动力学等因素有关。BACKGROUND:Mitral valve replacement with reserved subvalvular structure is an effective method for the treatment of valvular heart disease.The selection of prosthetic valve material plays an important role.OBJECTIVE:To explore application effect of biological mitral valve replacement in elderly patients with valvular heart disease.METHODS:Clinical data of 96 elderly patients with valvular heart disease who received mitral valve replacement from May 2017 to April 2019 in The 7th People’s Hospital of Zhengzhou were retrospectively analyzed.According to their conditions and wishes,the patients were divided into biological group(n=62)and mechanical group(n=34).The biological group received mitral valve replacement with reserved subvalvular structure biological valve.The mechanical group received mitral valve replacement with reserved subvalvular structure mechanical valve.Cardiac function,clinical efficacy,serum inflammatory factors,hemodynamics,and complications were compared between the two groups.This study was approved by the Ethics Committee of The 7th People’s Hospital of Zhengzhou(approval No.20170315).RESULTS AND CONCLUSION:(1)In follow-up for 12 months,New York Heart Association class I was 71%,and clinical success rate was 77%in the biological group.New York Heart Association class I was 47%,and clinical success rate was 53%in the mechanical group.There was significant difference of New York Heart Association class I and clinical success rate between two groups(P<0.05).There were no cases of reoperation or death caused by structural failure of artificial valve in the two groups.The thromboembolism,endocarditis and perivalvular leakage were lower in the biological group than those in the mechanical group(P<0.05).(2)At 3 days after surgery,mass concentrations of serum interleukin 6 and tumor necrosis factorαwere lower in the biological group than those in the mechanical group(P<0.05).The mass concentration of serum interleukin 10 was higher in the biological group than that in the mechanical group(P<0.05

关 键 词：老年 心脏瓣膜病 生物瓣膜 机械瓣膜 二尖瓣置换 炎性应激 血流动力学 

分 类 号：R459.9[医药卫生—治疗学] R318.08[医药卫生—临床医学]