二尖瓣修复术治疗风湿性二尖瓣狭窄疗效观察  

The effect of mitral valve repair for rheumatic mitral stenosis

作　　者：黄德荣 廖远峰 罗亮亮 汤全 刘达兴 Huang Derong;Liao Yuanfeng;Luo liangliang;Tang Quan;Liu Daxing(Department of Cardiovascular Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563100,China)

机构地区：[1]遵义医科大学附属医院心血管外科,遵义563100

出　　处：《中华胸心血管外科杂志》2022年第12期731-735,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：贵州省卫计委基金项目(gzxjkj2018-1-039)。

摘　　要：目的回顾性分析二尖瓣修复术对风湿性心脏病二尖瓣狭窄的治疗效果。方法50例风湿性心脏病二尖瓣狭窄患者行二尖瓣修复术(修复组),并纳入年龄、性别相匹配的50例行二尖瓣置换的患者(置换组),比较两组手术时间、体外循环时间、出血量、ICU时间、住院时间、术后心功能情况。随访2年,观察二尖瓣反流、心功能及并发症发生率。结果修复组的在体外循环时间、升主动脉阻断时间大于瓣膜置换组(P<0.05),而术后呼吸机使用时间、ICU停留时间、住院时间均小于置换组(P<0.05)。随访2年,两组均无患者死亡,修复组再住院率低于置换组(P<0.05),再手术率组间差异无统计学意义(P>0.05);修复组二尖瓣无中度及以上狭窄,中度反流1例(2%),二尖瓣置换组无瓣周漏,组间差异无统计学意义(P>0.05)。左心室舒张末期内径和左心室射血分数瓣膜修复组均优于置换组(P<0.05)。结论二尖瓣修复术治疗风湿性二尖瓣狭窄疗效确切,是一种安全、有效、可行的治疗方式。Objective To retrospectively evaluate the clinical effect of mitral valve repair for rheumatic mitral stenosis.Methods We retropectively analyze the clinical datd of 50 rheumatic mitral disease patients undergoing mitral valve repair from January 2016 to March 2019,the clinical outcome was compaired with those of patients undergoing mitral valve replacement.The operation time,cardiopulmonary bypass time,blood loss,ICU time,hospital stay,and postoperative cardiac function were analyzed,and followed up for 2 years to assess mitral regurgitation,cardiac function,and complication rates.Results The time of cardiopulmonary bypass and ascending aorta occlusion in the valve repair group were longer than those in the valve replacement group(P<0.05),and the postoperative ventilator assistance time,ICU stay time,and hospital stay were shorter than those in the valve replacement group(P<0.05).After 2 years of follow-up,no patients died in the two groups.The rehospitalization rate in the valve repair group was lower than that in the replacement group(P<0.05),and there was no significant difference in the reoperation rate between the groups(P>0.05);There was 1 case(2%)of moderate mitral valve regurgitation in the mitral valve repair group,no moderate or severe mitral valve stenosis,no paravalvular leakage in the mitral valve replacement group,and no significant difference between the two groups(P>0.05).The left ventricular end-diastolic diameter and left ventricular ejection fraction in the mitral valve repair group were significantly better than those in the mitral valve replacement group(P<0.05).Conclusion Mitral valve repair is effective in treating rheumatic mitral stenosis.It is beneficial to protect heart function,reduce postoperative anticoagulation complications,and does not increase the rate of reoperation.It is a safe,effective and feasible treatment.

关 键 词：风湿性心脏病 二尖瓣狭窄 二尖瓣修复术 二尖瓣置换术 

分 类 号：R654.2[医药卫生—外科学]