不同人工瓣膜置换治疗心脏瓣膜病的疗效观察  

Therapeutic Effect of Different Arfificial Valve Replacements in the Treatment of Valvular Heart Disease

作　　者：常明明 施超[1] 刘戈[1] 孟金金[1] 刁文杰 石宇[1] CHANG Mingming;SHI Chao;LIU Ge;MENG Jinjin;DIAO Wenjie;SHI Yu(Department of Cardiac Surgery,First Affiliated Hospital of Bengbu Medical College)

机构地区：[1]蚌埠医学院第一附属医院心脏外科,安徽蚌埠233000

出　　处：《长治医学院学报》2024年第2期120-123,共4页Journal of Changzhi Medical College

基　　金：安徽省科技攻关项目(1804h08020280)。

摘　　要：目的:探讨不同人工瓣膜置换治疗心脏瓣膜病(VHD)的疗效及对血清B型脑钠肽(BNP)和炎症因子的影响。方法:选取VHD患者100例,采用随机数字表法将患者分为生物瓣膜组(50例)和机械瓣膜组(50例)。对比2组临床疗效、安全性、血清BNP和炎症因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平。结果:2组总有效率比较差异无统计学意义(P>0.05);治疗12个月后,2组血清BNP水平较治疗前均降低(P<0.05),且生物瓣膜组[(117.19±13.19) ng·L^(-1)]低于机械瓣膜组[(136.95±14.86) ng·L^(-1)](P<0.05);术后3 d, 2组TNF-α、CRP和IL-6水平较治疗前均升高(P<0.05),但生物瓣膜组低于机械瓣膜组(P<0.05);2组瓣周漏、心内膜炎、血栓栓塞发生率比较,差异无统计学意义(P>0.05);机械瓣膜组出血事件发生率(16.00%)高于生物瓣膜组(4.00%)(P<0.05)。结论:生物瓣膜置换术治疗VHD的效果与机械瓣膜置换术相当,但术后炎症应激反应更轻,出血事件发生率更低。Objective:To investigate the efficacy of different valve replacements in the treatment of valvular heart disease(VHD)and its effect on serum B-type natriuretic peptide(BNP)and inflammatory cytokines.Methods:A total of 100 patients with VHD treated were selected.Patients were divided into two groups of the biological valve group(50 cases)and the mechanical valve group(50 cases)by random number generation method.The clinical efficacy,safety,serum BNP and inflammatory factors[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)]were compared between the two groups.Results:There was no significant difference in the comparison of the total effective rate between the two groups(P>0.05).After 12 months of treatment,the levels of serum BNP in the two groups were decreased when compared with those before treatment(P<0.05),and the levels in the biological valve group were lower than those in the mechanical valve group[(117.19±13.19)ng·L^(-1) vs(136.95±14.86)ng·L^(-1)](P<0.05).Three days after the operation,the levels of TNF-α,CRP and IL-6 in the two groups were higher than those before treatment(P<0.05),but the levels in the biological valve group were lower than those in the me-chanical valve group(P<0.05).There was no significant difference in the comparison of the incidences of perivalvular leak,endo-carditis and thromboembolism between the two groups(P>0.05).However,the incidence of bleeding events in the mechanical valve group was higher than that in the biological valve group(16.00%vs 4.00%)(P<0.05).Conclusion:The effect of biological valve replacement in the treatment of VHD is similar to that of mechanical valve replacement,but the postoperative inflammatory stress response is lighter and the incidence of bleeding events is lower.

关 键 词：生物瓣膜 机械瓣膜 心脏瓣膜病 B型脑钠肽 炎症因子 

分 类 号：R654.2[医药卫生—外科学]