右心房心肌纤维化程度对评估左心瓣膜术后孤立性三尖瓣反流手术预后的价值  

The value of right atrial myocardial fibrosis in evaluating the prognosis of isolated tricuspid valve surgery after left heart valve surgery

作　　者：杨燕晨 钟丽珊[2] 汪珍忠 杨亮 柯英杰 郭海江 何标川 周勘 赵俊飞[2] 黄焕雷 YANG Yanchen;ZHONG Lishan;WANG Zhenzhong;YANG Liang;KE Yingjie;GUO Haijiang;HE Biaochuan;ZHOU Kan;ZHAO Junfei;HUANG Huanlei(School of Medicine,South China University of Technology,Guangzhou,510006,P.R.China;Department of Cardiovascular Surgery,Guangdong Provincial Cardiovascular Institute,Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences),Guangzhou,510100,P.R.China;The University of Hong Kong-Shenzhen Hospital,Shenzhen,518048,Guangdong,P.R.China;Nanhai Hospital of Guangdong Provincial People's Hospital,Foshan,528253,Guangdong,P.R.China)

机构地区：[1]华南理工大学医学院,广州510006 [2]广东省人民医院(广东省医学科学院)广东省心血管病研究所心外科,广州510100 [3]香港大学深圳医院,广东深圳518048 [4]广东省人民医院南海医院,广东佛山528253

出　　处：《中国胸心血管外科临床杂志》2023年第7期1008-1013,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省基础与应用基础研究基金(2019B1515120071)。

摘　　要：目的 探讨右心房心肌纤维化程度在左心瓣膜术后孤立性三尖瓣反流手术预后中的预测价值。方法 纳入2016年4月-2021年8月因左心瓣膜术后远期出现孤立性重度三尖瓣关闭不全在广东省人民医院行三尖瓣成形术(由同一术者完成)患者。根据右心房心肌纤维化程度的不同分为轻度组、中度组和重度组,比较分析3组患者的临床资料。结果 共纳入患者75例,其中男16例、女59例,平均年龄(57.0±8.4)岁。轻度组30例,中度组29例,重度组16例。术前3组患者的心功能分级、右心房直径和三尖瓣关闭不全面积差异有统计学意义(P<0.05),而其他指标差异无统计学意义(P>0.05)。3组患者体外循环时间、机械通气时间、ICU监护时间、并发症发生率和死亡率差异有统计学意义(P<0.05)。进一步进行两两比较,与轻度组相比,重度组机械通气时间更长(P=0.024)、ICU监护时间更长(P=0.003)、术后并发症发生率更高(P=0.024),中度组各指标差异无统计学意义(P>0.05);与中度组相比,重度组ICU监护时间更长(P=0.021)、并发症发生率更高(P=0.006)。结论 存在右心房重度心肌纤维化的左心瓣膜术后孤立性三尖瓣反流患者行三尖瓣成形术的早期结果比轻度和中度患者差,提示右心房心肌纤维化程度可作为三尖瓣反流手术效果的预测指标和手术时机的判断指标。Objectivee To investigate the predictive value of right atrial myocardial fibrosis in the prognosis of isolated tricuspid regurgitation surgery after left heart valve surgery.Methods The patients who underwent tricuspid valvuloplasty by the same operator in Guangdong Provincial People's Hospital from April 2016 to August 2021 due to long-term isolated severe tricuspid regurgitation after left heart valve surgery were included in the study.According to the degree of right atrial myocardial fibrosis,the patients were divided into three groups:a mild group,a moderate group,and a severe group.The clinical data of these patients were compared and analyzed.Results A total of 75 patients were enrolled,including 16 males and 59 females with an average age of 57.0±8.4 years.There were 30 patients in the mild group,29 patients in the moderate group and 16 patients in the severe group.In terms of the preoperative data,there were statistical differences in cardiac function grade,right atrial diameter,tricuspid incompetence area among the three groups(P<0.05).In terms of the postoperative data,there were statistical differences among the three groups in the cardiopulmonary bypass time,mechanical ventilation time,ICU monitoring time,complication rate and mortality(P<0.05).Further pairwise comparison showed that,compared with the mild group,the severe group had longer mechanical ventilation time(P=0.024),longer ICU monitoring time(P=0.003)and higher incidence of postoperative complications(P-0.024),while the moderate group had no statistical difference in all aspects(P>0.05);compared with the moderate group,the severe group had longer ICU monitoring time(P=0.021)and higher incidence of complications(P-0.006).Conclusion The early outcome of tricuspid valvuloplasty in patients with isolated tricuspid regurgitation after left heart valve surgery with severe right atrial myocardial fibrosis is worse than that in the patients with mild and moderate fibrosis,suggesting that the degree of myocardial fibrosis in the right atrium can b

关 键 词：左心瓣膜置换 孤立性 三尖瓣关闭不全 三尖瓣成形 心肌纤维化 

分 类 号：R654.2[医药卫生—外科学]