左室质量与慢性缩窄性心包炎手术效果的关系研究  

Relationship between left ventricular mass and surgical outcome of chronic constrictive pericarditis

作　　者：张耀中 张雅娉[1] 郭建中[1] 张永[1] Zhang Yaozhong;Zhang Yaping;Guo Jianzhong;Zhang Yong(Cardiovascular Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院心血管中心,100050

出　　处：《中国心血管杂志》2022年第6期548-551,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨慢性缩窄性心包炎(CCP)患者的左室质量与CCP手术效果之间的关系。方法回顾性纳入2000年1月至2020年12月于北京友谊医院行手术治疗的28例CCP患者,收集术前、术中、术后临床资料,根据左室质量指数值将CCP患者分为两组:左室质量正常组和左室质量下降组,比较两组行心包剥脱手术后的并发症和住院期间死亡率。结果28例CCP患者接受了心包剥脱术,64.3%术前NYHAⅢ~Ⅳ级,82.1%术前左室收缩功能正常,60.7%术前存在心包钙化。患者术后中心静脉压较术前明显下降[(9.0±2.6)cmH_(2)O比(16.0±4.7)cmH_(2)O,t=6.656,P=0.000],左室射血分数值较术前升高(67.0%±6.8%比59.0%±7.5%,t=-6.817,P=0.002),收缩压较术前增高[(124.0±11.1)mmHg比(110.0±10.0)mmHg,t=-7.525,P=0.000],术后NYHAⅠ~Ⅱ级患者比例增多(Z=-2.982,P=0.003)。5例患者术后出现并发症,2例患者术后死亡,住院死亡率为7.1%。左室质量下降组的手术并发症发生率(Z=9.82,P=0.002)和住院期间死亡率(Z=6.462,P=0.011)均明显高于左室质量正常组。结论CCP患者心包剥脱术后并发症和住院期间死亡率与左室质量有关,在考虑手术风险时应评估心室质量和心肌是否已经发生萎缩。Objective To investigate the relationship between left ventricular mass and the surgical outcome in patients with chronic constrictive pericarditis(CCP)after pericardiectomy.Methods A total of 28 patients with CCP who underwent surgical treatment in Beijing Friendship Hospital from January 2000 to December 2020 were included in this retrospective study.The preoperative,intraoperative and postoperative clinical data were collected.According to left ventricular mass index(LVMI),CCP patients were divided into the normal LVMI group and the decreased LVMI group.The complications and in-hospital mortality of pericardiectomy were compared between the two groups.Results In 28 patients with CCP underwent pericardiectomy,64.3%of them with NYHA classⅢtoⅣ,82.1%had normal left ventricular systolic function before pericardiectomy,and 60.7%had pericardial calcification.The central vein pressure(CVP)decreased significantly after surgery[(9.0±2.6)cmH_(2)O vs.(16.0±4.7)cmH_(2)O,t=6.656,P=0.000].Ejection fraction increased(67.0%±6.8%vs.59.0%±7.5%,t=-6.817,P=0.002)and systolic blood pressure increased[(124.0±11.1)mmHg vs.(110.0±10.0)mmHg,t=-7.525,P=0.000]after surgery.The proportion of patients with NYHA classⅠtoⅡincreased(Z=-2.982,P=0.003)after surgery.Postoperative complications occurred in 5 patients.Postoperative death occurred in 2 patients.The in-hospital mortality rate was 7.1%.The incidences of surgical complications and in-hospital mortality were significantly higher in the decreased LVMI group than those in the normal LVMI group(Z=9.82,P=0.002;Z=6.462,P=0.011).Conclusions Post-pericardial denudation complications and in-hospital mortality in CCP patients are related to the left ventricle mass,and ventricular mass and myocardial atrophy should be assessed when considering surgical risks.

关 键 词：慢性缩窄性心包炎 心包剥脱术 左室质量 心肌萎缩 

分 类 号：R654.2[医药卫生—外科学]