改良DeVega成形与人工瓣环成形治疗三尖瓣关闭不全的效果比较  

Comparison of the clinical efficacy of modified DeVega valvuloplasty verse artifical annuloplasty in patient with tricuspid regurgitation

作　　者：王冲[1] 顾亮[1] 赵强[2] WANG Chong;GU Liang;ZHAO Qiang(Department of Cardiothoracic Surgery,Nantong Rich Hospital,Rich Hospital Affiliated to Nantong University,Nantong 226010;Department ofCardiac Surgery,Shanghai Ruijin Hospital)

机构地区：[1]南通瑞慈医院,南通大学附属瑞慈医院心胸外科,南通226010 [2]上海瑞金医院心脏外科

出　　处：《南通大学学报（医学版）》2022年第1期19-23,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市“十四五”科教强卫工程医学重点人才专项基金资助项目。

摘　　要：目的:探讨心脏瓣膜病合并三尖瓣关闭不全同期行人工瓣环成形与改良DeVega成形后的三尖瓣反流及右心功能,总结相关的临床经验。方法:选择在南通大学附属瑞慈医院手术的心脏瓣膜病合并三尖瓣关闭不全的60例患者为研究对象,根据体外循环心脏直视手术中同期三尖瓣成形方式的不同分为改良DeVega组和人工成形环组,各30例。比较两组患者术前1 d和术后6、12个月的心功能状况及心脏超声学指标包括左心室射血分数(left ventricular ejection fraction,LVEF)、右心房内径(right atrial diameter,RAD)、右心室内径(right ventricular diameter,RVD)、三尖瓣环内径(tricuspid regurgitation degree,TRD)、三尖瓣反流面积(tricuspid regurgitation area,TRA)、肺动脉收缩压(pulmonary artery systolic pressure,PASP)、Tei指数。结果:两组患者术前RAD、RVD、TRA、TRD比较差异均无统计学意义(均P>0.05),术后6、12个月较术前均明显下降(均P<0.05)。与改良DeVega组相比,人工成形环组患者术后6个月TRA、TRD改善更为显著,而术后12个月RVD、RAD降低更为显著(P<0.05)。两组患者治疗后PASP、Tei指数明显降低,LVEF明显升高。人工成形环组患者术后12个月的PASP、Tei指数明显低于改良DeVega组。结论:改良DeVega成形和人工瓣环成形对三尖瓣关闭不全都有良好的效果。人工瓣环成形能重塑三尖瓣空间立体结构,防止瓣环变形,明显减少三尖瓣的反流,效果更好。Objective:To explore the tricuspid regurgitation and right ventricular function in patients with valvular heart disease with tricuspid regurgitation after artificial annuloplasty versu modified DeVega valvuloplasty.Methods:Sixty patients with tricuspid regurgitation who underwent valve replacement in Rich Hospital Affiliated to Nantong University were selected and divided into artificial annuloplasty group(n=30)and modified DeVega valvuloplasty group(n=30).The two groups were compared in terms of cardiac function and cardiac B-ultrasonic indices at 6,12 months after operation:Tei index,left ventricular ejection fraction(LVEF),right atrial diameter(RAD),right ventricular diameter(RVD),tricuspid regurgitation degree(TRD),tricuspid regurgitation area(TRA),pulmonary artery systolic pressure(PASP)and Tei index.Results:There was no significant difference in RAD,RVD,TRA and TRD before operation between the two groups(P>0.05).The corresponding values at 6 and 12 months after operation were significantly lower than those before operation(P<0.05).Compared with modified DeVega valvuloplasty group,TRA and TRD in artificial annuloplasty group improved more obviously at 6 months postoperatively,RVD and RAD in artificial annuloplasty group decreased more significantly at 12 months postoperatively(P<0.05).After treatment,PASP and Tei intex decreased significantly,LVEF increased significantly in both groups.The PASP and Tei index in the artificial annuloplasty group were significantly lower than those in the modified DeVega valvuloplasty group at 12 months after operation.Conclusion:Both modified DeVega valvuloplasty and artifical annuloplasty for tricuspid regurgitation have good results.However,artifical annuloplasty which can reshape the three-dimensional structure of the tricuspid valve,prevent the deformation of the tricuspid ring,reduce the regurgitation of the tricuspid valve,has better effect.

关 键 词：三尖瓣关闭不全 心脏瓣膜病 人工瓣环 改良DeVega成形术 

分 类 号：R654.2[医药卫生—外科学]