主动脉瓣成形术在主动脉瓣关闭不全外科治疗中的近期效果分析  

Analysis of short-term effect of aortic valvuloplasty in surgical treatment of aortic insufficiency

作　　者：马金磊 徐高俊 张崇 张桥 赵豪 钱向阳 葛振伟 MA Jin-lei;XU Gao-jun;ZHANG Chong;ZHANG Qiao;ZHAO Hao;QIAN Xiang-yang;GE Zhen-wei(Department of Cardiac Surgery,Central China Fuwai Hospital,Henan Provincial Poeple's Hospital,Zhengzhou University Peopley s Hospital,Zhengzhou 450003,China;Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Scineces,Beijing 100037,China)

机构地区：[1]郑州大学人民医院,河南省人民医院心脏中心,阜外华中心血管病医院心血管外科,河南省郑州市450003 [2]中国医学科学院阜外医院血管外科中心

出　　处：《中国心血管病研究》2022年第4期323-328,共6页Chinese Journal of Cardiovascular Research

基　　金：河南省医学科技攻关计划项目(SBGJ202002029)。

摘　　要：目的 分析主动脉瓣成形术(AVP)治疗主动脉瓣关闭不全(AI)的近期效果。方法 回顾性分析2018年1月至2020年12月选取的29例因主动脉瓣关闭不全在阜外华中心血管病医院行主动脉瓣成形术的患者为成形组,并随机收集同期30例因主动脉瓣关闭不全行主动脉瓣置换术的患者作为对照(置换组),出院后通过门诊复查和电话进行随访,随访患者59人,术后平均随访(14.7±5.2)个月,对比分析两组术前、围术期、术后的心脏超声指标及一般资料。结果 术前超声心动图显示,成形组和置换组的左心室舒张末期内径(LVEDd)[61.0(56.5,69.0)mm比65.0(60.8,71.3)mm,P>0.05]、主动脉瓣最大跨瓣压差(PPG)[19.0(17.0,20.0)mmHg比20.5(14.8,32.8)mmHg,P>0.05]、主动脉瓣口峰值流速(PK)[2.0(1.9,2.2)m/s比2.2(1.9,2.7)m/s,P>0.05]和左心室射血分数(LVEF)[56.0(51.5,59.5)%比56.5(51.8,60.0)%,P>0.05]差异无统计学意义。成形组和置换组围术期在体外循环时间、主动脉阻断时间[(137.5±22.2)min比(112.7±19.2)min,99.0(85.5,108.5)min比72.0(63.5,89.5)min,均P<0.05]方面存在统计学差异,即成形组术中用时更多。在术中出血量、术后ICU时间及术后住院总时间[400.0(200.0,700.0)ml比400.0(200.0,525.0)ml,2.0(2.0,3.0)d比2.0(2.0,3.0)d,11.0(9.5,15.5)d比11.0(8.8,16.0)d,均P>0.05]等方面无统计学差异。术后随访1年时超声心动图显示,两组的LVEDd和LVEF[49.0(42.0,51.5)mm比48.0(45.8,51.0)mm,61.0(57.0,66.5)%比62.0(56.8,65.0)%,均P>0.05]对比,差异无统计学意义;而成形组的PPG和PK[8.0(6.0,12.0)mmHg比20.5(15.0,29.3)mmHg,1.4(1.3,1.7)m/s比2.3(2.0,2.7)m/s,均P<0.05]优于置换组。结论 与主动脉瓣置换术相比,主动脉瓣成形术治疗主动脉瓣关闭不全具有良好的近期手术效果。Objective To investigate the short-term results of aortic valvuloplasty(AVP) for aortic insufficiency(AI).Methods From January 2018 to December 2020,29 patients with aortic valve insufficiency who underwent aortic valvuloplasty were selected as the plastic group in The Central China Fuwai Hospital,and a total of 30 patients with aortic valve replacement due to aortic insufficiency were randomly collected as the control group.All of the 59 patients were followed up through out-patient review and telephone after discharge from hospital.The average follow-up time was(14.7 ± 5.2) months;the preoperative,perioperative and postoperative echocardiographic indexes and general data of the two groups were compared.Results The preoperative echocardiography in the plastic and replacement groups showed:left ventricular end-diastolic dimension [LVEDd][61.0(56.5,69.0)mm vs.65.0(60.8,71.3)mm,P>0.05],peak pressure gradient(PPG)[19.0(17.0,20.0)mm Hg vs.20.5(14.8,32.8)mm Hg,P>0.05],peak(velocity of aortic valve orifice)(PK) [2.0(1.9,2.2)m/s vs.2.2(1.9,2.7)m/s,P>0.05] and left ventricular ejection fraction(LVEF)[56.0(51.5,59.5)% vs.56.5(51.8,60.0)%,P>0.05];there was no significant difference.There were significant differences between the two groups in terms of cardiopulmonary bypass time and aortic occlusion time [(137.5±22.2)min vs.(112.7±19.2)min,99.0(85.5,108.5)min vs.72.0(63.5,89.5)min,P<0.05],that is,the plastic group used more time in surgery.There was no significant difference in the amount of blood loss during the operation,postoperative ICU time and postoperative hospital stay [400.0(200.0,700.0)ml vs.400.0(200.0,525.0)ml,2.0(2.0,3.0)day vs.2.0(2.0,3.0)day,11.0(9.5,15.5)day vs.11.0(8.8,16.0)day,P>0.05].Postoperative follow-up 1 year echocardiography showed:there were no significant differences between the two groups in terms of LVEDd and LVEF [49.0(42.0,51.5)mm vs.48.0(45.8,51.0)mm,61.0(57.0,66.5)% vs.62.0(56.8,65.0)%,P>0.05];the PPG and PK [8.0(6.0,12.0)mm Hg vs.20.5(15.0,29.3)mm Hg,1.4(1.3,1.7)m/s vs.2.3(2.0,2.7)m/s,P<

关 键 词：主动脉瓣关闭不全 主动脉瓣成形术 主动脉瓣置换术 

分 类 号：R654.2[医药卫生—外科学]