风湿性联合瓣膜病行单纯二尖瓣置换与联合瓣膜置换的中远期疗效比较  

Comparison of long-term efficacy of mitral valve replacement and combined valve replacement in rheumatic combined valvular disease

作　　者：程少鹏 赵鑫[1] 李守明 宋晗 王振华 韦铎亮 CHENG Shao-peng;ZHAO Xin;LI Shou-ming;SONG Han;WANG Zhen-hua;WEI Duo-liang(Department of Cardiac Surgery,Qilu Hospital of Shandong University,Jinan 266035,China)

机构地区：[1]山东大学齐鲁医院心脏外科,山东省济南市266035

出　　处：《中国心血管病研究》2022年第4期317-322,共6页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(青年科学基金项目)(81500367)。

摘　　要：目的 探讨二尖瓣置换术同时伴有主动脉瓣轻度及轻中度病变的风湿性心脏病患者群体的最佳治疗方案。方法 回顾性分析2015年1月至2019年12月在山东大学齐鲁医院诊断为风湿性联合瓣膜病的140例患者的临床资料,所有的患者均行二尖瓣机械瓣置换并且主动脉瓣有轻度及轻中度病变。将其分为A、B两组,其中A组88例仅行二尖瓣置换,B组52例行联合瓣膜置换。比较两组患者的手术时间、术后并发症、术后主动脉跨瓣压差及远期生存率等指标。结果 140例患者中,男性50例,女性90例,平均年龄(55.64±8.94)岁。与A组相比,B组在手术时间、体外循环时间、阻断时间均长于A组,B组术后主动脉跨瓣压差高于A组(P均<0.05)。患者术后随访数据来自患者门诊复查以及电话随访,中位随访时间为50个月。所有患者中,术后早期死亡3例,其中A组2例(1例心源性猝死,1例术中死亡),B组1例(术后肝衰竭);晚期死亡5例,其中心源性死亡2例(1例为全心衰竭,1例为急性心肌梗死),糖尿病并发症死亡1例,意外事故死亡1例,不明原因死亡1例;手术再干预2例(1例为术后一年行介入心房颤动射频消融术,1例为二尖瓣置换术后32个月后因主动脉瓣反流行主动脉瓣机械瓣置换术)。多因素Cox回归分析模型显示,年龄、左心室射血分数、手术时间是独立危险因素(HR>1,P<0.05)。结论 风湿性联合瓣膜合并轻中度主动脉瓣病变的患者,对主动脉瓣采取保守的策略可减少手术时间、体外循环时间、心肌缺血时间,远期可减低因人工瓣膜不匹配发生左心功能逐渐损害、升主动脉扩张的风险。Objective To explore the best treatment for the patients with rheumatic heart disease after mitral valve replacement with mild and mild to moderate aortic valve lesions.Methods A total clinical data of140 patients diagnosed with combined rheumatic valvular disease in Qilu Hospital of Shandong University from January 2015 to December 2019 were retrosectively analyzed.All the patients underwent mechanical mitral valve replacement and had mild and mild to moderate aortic valve lesions.The patients were divided into two groups:88 patients in the group A underwent mitral valve replacement only and 52 patients in the group B underwent combined valve replacement.The operative time,postoperative complications,postoperative aortic valve differential pressure and long-term survival rate were compared between the two groups.Results Among the 140patients,there were 50 males and 90 females,with an average age of(55.64±8.94)years.Compared with the group A,the operative time,CPB time and blocking time of group B were longer than that of the group A,and the postoperative aortic valve differential pressure of group B was higher than group A(P<0.05).The postoperative follow-up data were obtained from outpatient review and telephone follow-up,and the median follow-up time was50 months.Among all the patients,there were 3 early postoperative deaths,including 2 in group A(1 sudden cardiac death,1 intraoperative death) and 1 in group B(postoperative liver failure).There were 5 late deaths,including 2 central deaths(1 total heart failure and 1 acute myocardial infarction),1 death due to diabetes complications,1 death due to accidents and 1 death due to unknown causes.The 2nd surgical intervention was performed in 2 patients(1 patient underwent interventional radiofrequency ablation of atrial fibrillation one year after surgery and 1 patient underwent mechanical aortic valve replacement due to reverse aortic valve replacement32 months after surgery).Cox regression analysis model showed that age,left ventricular ejection fraction and the

关 键 词：风湿性心脏病 二尖瓣置换 主动脉瓣置换 主动脉跨瓣压差 

分 类 号：R654.2[医药卫生—外科学]