两种手术方式治疗重度主动脉瓣病变合并轻中度或中度功能性二尖瓣关闭不全的临床疗效  

Clinical efficacy of two surgical methods in treating severe aortic valve disease complicated with mild to moderate or moderate functional mitral regurgitation

作　　者：谭雄[1] 李金洁[2] 梅波[1] 何光杰[1] 金伟涛 王亮[1] 张建 赖应龙[1] TAN Xiong;LI Jinjie;MEI Bo(Department of Cardiovascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,CHINA)

机构地区：[1]川北医学院附属医院心脏大血管外科,四川南充637000 [2]川北医学院附属医院手术中心,四川南充637000

出　　处：《江苏医药》2023年第12期1193-1196,1202,共5页Jiangsu Medical Journal

基　　金：川北医学院附属医院院内课题(2021JC050)。

摘　　要：目的比较两种手术方式治疗重度主动脉瓣病变合并轻中度或中度功能性二尖瓣关闭不全(FMR)的临床疗效。方法64例重度主动脉瓣病变合并轻中度或中度FMR患者均在体外循环(CPB)下行主动脉瓣置换术(AVR),随机分为二尖瓣未修复组(A组,30例)和二尖瓣修复组(B组,34例)。收集两组围手术期资料,并于术后定期进行心脏超声随访。结果A组CPB时间、主动脉阻断时间和住院费用少于B组(P<0.05)。与术前相比,两组术后纽约心脏病协会(NYHA)心功能分级、左心房内径(LAD)、左心室舒张末期内径(LVEDD)、二尖瓣返流面积和二尖瓣前后叶对合缘高度均改善(P<0.05),而左心室射血分数(LVEF)未见明显变化(P>0.05);B组术后1个月时二尖瓣返流面积小于A组(P<0.05);两组术后12、24个月时NYHA心功能分级、LAD、LVEDD、LVEF、二尖瓣返流面积和二尖瓣前后叶对合缘高度差异均无统计学意义(P>0.05)。结论对于重度主动脉瓣病变合并轻中度或中度FMR患者,未进行二尖瓣修复是一种安全、有效的治疗方式,可缩短手术时间,降低手术风险,减少医疗费用,并对预后和并发症的发生无显著影响。Objective To compare the clinical outcomes of two surgical methods in the treatment of severe aortic valve disease complicated with mild to moderate or moderate functional mitral regurgitation(FMR).Methods A total of 64 patients with severe aortic valve disease complicated with mild to moderate or moderate FMR accepted aortic valve replacement(AVR)under cardiopulmonary bypass(CPB),who were randomly divided into two groups of A(without mitral valve repair,30 cases)and B(with mitral valve repair,34 cases).The perioperative data were collected and the ultrasonic cardiogram following up was regularly performed after surgery.Results The CPB time,aortic occlusion time and hospitalization expense in group A were less than those in group B(P<0.05).Compared with before operation,the New York Heart Association(NYHA)grading,left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),mitral regurgitation area,and commissural height of anterior and posterior mitral leaflet were improved(P<0.05),while the left ventricular ejection function(LVEF)was not obviously changed after operation in both groups(P>0.05).The mitral regurgitation area in the 1s"month after operation in group B was smaller than that in group A(P<0.05).There were no statistical differences in the NYHA grading,LAD,LVEDD,LVEF,mitral regurgitation area and commissural height of anterior and posterior mitral leaflet in the 12th and 24th month after operation between the two groups(P>0.05).Conclusion In the patients with severe aortic valve disease complicated with mild to moderate or moderate FMR,AVR without mitral valve repair is a safe and effective surgical method,which has the advantages of shortening operation time,reducing surgical risk,decreasing the medical expenditure without obvious effect on the prognosis and occurrence of complications.

关 键 词：主动脉瓣病变 功能性二尖瓣关闭不全 体外循环 

分 类 号：R654[医药卫生—外科学]