中-重度缺血性二尖瓣关闭不全外科治疗的中期效果  

Mid-term effect of surgical treatment for moderate to severe ischemic mitral regurgitation

作　　者：金岩 陶登顺 王辉山 姜辉 赵洋 贺元辰 徐殊 张永 岳凤捷 JIN Yan;TAO Dengshun;WANG Huishan;JIANG Hui;ZHAO Yang;HE Yuanchen;XU Shu;ZHANG Yong;YUE Fengjie(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang,110016,P.R.China)

机构地区：[1]北部战区总医院心血管外科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2023年第12期1714-1719,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(82070239)。

摘　　要：目的 探讨中-重度缺血性二尖瓣关闭不全(ischemic mitral regurgitation,IMR)患者治疗方案及疗效评价。方法 回顾性分析2014年6月—2019年6月于北部战区总医院接受外科治疗的冠状动脉粥样硬化性心脏病合并中-重度IMR患者的临床资料。按手术方式将患者分为两组:冠状动脉旁路移植术(coronary artery bypass grafting,CABG)组(CABG组),CABG+二尖瓣手术(mitral valve surgery,MVS)组(CABG+MVS组)。对两组患者的术前、术后临床资料进行对比分析。结果 共纳入105例患者,其中男75例、女30例,年龄40~79(62.70±7.90)岁。CABG组34例,CABG+MVS组71例(二尖瓣成形42例、二尖瓣置换29例)。围术期死亡5例,术后3个月死亡2例,7例均为CABG+MVS组患者,两组围术期和术后3个月死亡率差异无统计学意义(P=0.14)。中远期随访87例,两组患者术前二尖瓣反流程度(P=0.59)和左房内径(P=0.51)差异无统计学意义,而术后CABG组患者的二尖瓣反流程度明显大于CABG+MVS组(P<0.01),但CABG组左房内径明显小于CABG+MVS组(P<0.01)。配对分析显示肺动脉收缩压、左室舒张末期内径、左室收缩末期内径、左室射血分数和二尖瓣反流程度在术后均有明显改善(P<0.01),左房内径在CABG组术后有明显改善(P<0.01),而CABG+MVS组术前术后差异无统计学意义(P=0.10)。结论 对于中-重度IMR患者,CABG同期行二尖瓣处理可以改善左室重构,但不能显著改善左房重构,CABG是否同期行二尖瓣处理应慎重;对于高龄、身体状况差、预期寿命短的患者,单独CABG是一种安全有效方案。Objective To investigate surgical treatment and evaluate the curative effect in patients with moderate to severe ischemic mitral regurgitation(IMR).Methods The clinical data of the patients with coronary heart disease complicated with moderate to severe IMR who agreed to receive surgical treatment from June 2014 to June 2019 in our hospital were analyzed retrospectively.The patients were divided into two groups:a coronary artery bypass grafting(CABG)group and a CABG+mitral valve surgery(MVS)group.The preoperative and postoperative clinical data between the two groups were compared.Results Finally 105 patients were collected,including 75 males and 30 females,aged 40-79(62.70±7.90)years.There were 34 patients in the CABG group,and 71 patients in the CABG+MVS group including 2 patients of mitral valvuloplasty and 29 patients of mitral valve replacement.Among the 105 patients,5 died during the perioperative period and 2 died in 3 months after operation,all of whom were from the CABG+MVS group.There was no statistical difference in perioperative and postoperative 3-month mortality rate between the two groups(P=0.14).Eightyseven patients were followed up in the medium and long term.There was no statistical difference in the degree of preoperative mitral insufficiency(MI)(P=0.59)and left atrium diameter(P=0.51)between the two groups,but the degree of postoperative MI in the CABG group was significantly higher than that in the CABG+MVS group(P<0.01).However,the left atrium diameter in the CABG group was significantly smaller than that in the CABG+MVS group(P<0.01).Paired analysis showed that systolic pulmonary artery pressure,left ventricular end-diastolic diameter,left ventricular endsystolic diameter,left ventricular ejection fraction and MI were significantly improved after operation(P<0.01);left atrium diameter was significantly improved after operation in the CABG group(P<0.01),but there was no statistical difference before and after operation in the CABG+MVS group(P=0.10).Conclusion For patients with moderate to s

关 键 词：缺血性二尖瓣关闭不全 二尖瓣手术 冠状动脉旁路移植术 左室重构 超声心动图 

分 类 号：R654.2[医药卫生—外科学]