腔镜辅助下右胸骨旁第2肋间横切口入路主动脉瓣置换术的应用效果  

Application of endoscopically assisted right parasternal second intercostal transverse incision approach aortic valve replacement in patients with aortic valve disease

作　　者：王保才 程兆云 陈现杰 胡俊龙 朱喜亮 孙俊杰 轩继中 WANG Baocai;CHENG Zhaoyun;CHEN Xianjie;HU Junlong;ZHU Xiliang;SUN Junjie;XUAN Jizhong(Department of Cardiovascular Surgery,Fuwai Central China Cardiovascular Hospital(Heart Center of Henan Provincial People′s Hospital),Department of Cardiovascular Surgery,Zhengzhou University People′s Hospital,Zhengzhou 450003)

机构地区：[1]阜外华中心血管病医院(河南省人民医院心脏中心)心血管外科,郑州大学人民医院心血管外科,郑州450003

出　　处：《郑州大学学报（医学版）》2024年第5期731-735,共5页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:观察腔镜辅助下右胸骨旁第2肋间横切口入路主动脉瓣置换术的应用效果。方法:选取2020年1月至2023年5月河南省人民医院收治的86例单纯主动脉瓣病变患者,均行主动脉瓣置换术治疗,其中采取正中切口入路42例(对照组),采取腔镜辅助下右胸骨旁第2肋间横切口入路44例(观察组)。观察两组手术相关指标、并发症、疼痛NRS评分及手术前后血流动力学指标[左室射血分数(LVEF)、每搏输出量(SV)、心排血量(CO)],心室重构指标[左心房内径(LAD)、左室舒张末期内径(LVEDD)、右心室内径(RV)],氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、髓过氧化物酶(MPO)]的变化。结果:观察组体外循环、升主动脉阻断时长大于对照组,切口长度、心外重症监护病房入住时长、术后住院时长小于对照组(P<0.05)。术后1、3、7 d,两组NRS评分均先升高后下降,且观察组NRS评分低于对照组(P<0.05);两组术后LVEF、SV、CO均升高,LVEDD、LAD、RV均降低(P<0.05),但两组间差异无统计学意义(P>0.05);术后3、7 d,两组MPO、MDA水平均较术前升高,SOD水平较术前降低,且观察组上述指标的改善优于对照组(P<0.05)。观察组房颤发生率为9.1%,低于对照组的31.0%(P<0.05)。结论:腔镜辅助下右胸骨旁第2肋间横切口入路主动脉瓣置换术治疗主动脉瓣病变,可改善心脏血流动力学,部分逆转心室重构,减轻术后疼痛及氧化应激反应,降低术后房颤风险,加速康复进程。Aim:To observe the application of endoscopically assisted right parasternal second intercostal transverse incision approach aortic valve replacement in patients with aortic valve disease.Methods:A total of 86 patients with simple aortic valve disease treated in Fuwai Central China Cardiovascular Hospital from January 2020 to May 2023 were selected.The patients with median incision approach were included in control group(n=42),and the patients with endoscopically assisted right parasternal second intercostal transverse incision approach were included in the observation group(n=44).Perioperative indexes,NRS score,complications,hemodynamics indexes[left ventricular ejection fraction(LVEF),stroke output(SV),cardiac output(CO)],ventricular remodeling indexes[left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),right ventricular diameter(RV)],oxidative stress indexes[superoxide dismutase(SOD),malondialdehyde(MDA),myeloperoxidase(MPO)]changes of the 2 groups were observed.Results:The durations of cardiopulmonary bypass and ascending aorta occlusion in the observation group were longer than those in control group,and the length of incision,CSICU admission and postoperative hospitalization were shorter than those in control group(P<0.05).The NRS score increased first and then decreased on the 1st,3rd,and 7th day after operation,and the NRS score of the observation group was lower than that of control group(P<0.05).After operation,LVEF,SV and CO increased while LVEDD,LAD and RV decreased in the 2 groups(P<0.05),but there was no significant difference between the 2 groups(P>0.05).On the 3rd and 7th day after operation,MPO and MDA levels in the 2 groups were both increased and SOD level decreased,and the observation group had better improvements(P<0.05).The incidence of atrial fibrillation in the observation group was 9.1%,lower than that in control group(31.0%,P<0.05).Conclusion:Endoscopically assisted right parasternal second intercostal transverse incision approach aortic valve replacement in the treat

关 键 词：主动脉瓣病变 心室重构 主动脉瓣置换术 氧化应激 

分 类 号：R654.2[医药卫生—外科学]