中度缺血性二尖瓣关闭不全合并左室收缩功能减退的外科治疗效果分析  

Surgical treatment of moderate ischemic mitral regurgitation complicated with reduced left ventricular ejection fraction

作　　者：姚皓弋 刘赟[1] 秦凯捷 周密[1] 王哲[1] 陈安清[1] 赵强[1] 李海清[1] YAO Haoyi;LIU Yun;QIN Kaijie;ZHOU Mi;WANG Zhe;CHEN Anqing;ZHAO Qiang;LI Haiqing(Department of Cardiovascular Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院心脏外科,上海200025

出　　处：《上海交通大学学报（医学版）》2022年第5期629-634,共6页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·探索左室收缩功能减退的慢性中度缺血性二尖瓣关闭不全(ischemic mitral regurgitation,IMR)冠心病患者不同手术方式的疗效。方法·纳入2013年5月—2019年5月于上海交通大学医学院附属瑞金医院心脏外科行外科治疗的左室射血分数(left ventricular ejection fraction,LVEF)<50%的慢性中度IMR患者31例。根据是否合并二尖瓣成形(mitral valve plasty,MVP)手术,分为非体外冠状动脉旁路移植(off-pump coronary artery bypass grafting,OPCABG)组与CABG+MVP组。收集术前、术后以及随访时心脏超声资料和围术期并发症情况,评价手术疗效。结果·OPCABG组12例患者,CABG+MVP组19例。术后CABG+MVP组死亡1人,较于OPCABG组,死亡率无显著差异(5.3%vs 0),但二尖瓣反流程度显著减轻(P=0.000),重症监护室(intensive care unit,ICU)停留时间显著延长[3.0(1.0,4.0)d vs 1.0(1.0,2.0)d,P=0.027]。随访时间为48.7(30.2,66.5)个月,2组患者的死亡率、二尖瓣反流程度、LVEF以及各并发症比较差异无统计学意义。结论·OPCABG术治疗LVEF降低的慢性中度IMR患者并发症比CABG+MVP少,有利于患者快速康复,近中期疗效满意。Objective·To explore different surgical strategies in patients of moderate ischemic mitral regurgitation(IMR)complicated with reduced left ventricular ejection fraction(LVEF).Methods·From May 2013 to May 2019,31 patients diagnosed as moderate IMR with LVEF<50%received surgical treatment in Department of Cardiovascular Surgery in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine.The patients were divided into off-pump coronary artery bypass grafting(OPCABG)group and CABG+mitral valve plasty(MVP)group according to whether or not mitral valve procedure was performed.Preoperative,postoperative and follow-up echocardiography data and perioperative complications were compared to evaluate the surgical efficacy.Results·There were 12 patients in OPCABG group and 19 patients in CABG+MVP group.1 patient died in CABG+MVP group postoperatively,which showed no significant difference in mortality(5.3%vs 0)between the groups.The degree of mitral regurgitation was significantly reduced in CABG+MVP group(P=0.000),while intensive care unit(ICU)length of stay significantly increased[3.0(1.0,4.0)d vs 1.0(1.0,2.0)d,P=0.027].After 48.7(30.2,66.5)months of follow-up,there were no significant differences in mortality,degree of mitral regurgitation,LVEF and complications between the two groups.Conclusion·OPCABG procedure treating chronic moderate IMR with reduced LVEF could be beneficial for enhanced recovery after surgery and has satisfactory early and mid-term efficacy.

关 键 词：缺血性二尖瓣关闭不全 左室收缩功能减退 非体外循环下冠状动脉旁路移植术 二尖瓣成形术 术后快速康复 

分 类 号：R654.2[医药卫生—外科学]