冠状动脉旁路移植术中二尖瓣反流变化程度对术后二尖瓣功能改善的预测价值  

The predictive value of mitral regurgitation degree change in coronary artery bypass grafting for mitral valve function improvement

作　　者：杜江川[1] 霍婷婷[1] 于瑞娜[1] 滑少华[1] DU Jiangchuan;HUO Tingting;YU Ruina;HUA Shaohua(Department of Ultrasound Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院超声科,450052

出　　处：《心肺血管病杂志》2025年第1期45-51,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：2024年河南省自然科学基金(242300421274)。

摘　　要：目的:探讨缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)患者在CABG术中,全麻状态下二尖瓣反流程度较术前的变化,分析其对CABG术后二尖瓣功能改善的预测价值。方法:回顾性分析术前为中度及以上IMR的CABG患者101例,根据术后1个月复查超声心动图二尖瓣反流情况,分为改善组(MR程度较术前至少改善一个等级)及未改善组。对比两组术前、术中二尖瓣反流程度以及术前常规资料,分析CABG术后二尖瓣反流改善的相关预测因素。结果:(1) 101例患者中CABG术后65例IMR改善,36例IMR未改善。改善组与未改善组间术前二尖瓣反流程度差异无统计学意义(P> 0.05),术中、术后二尖瓣反流程度以及术中二尖瓣反流变化程度具有显著性差异(P均<0.05),两组间年龄、术中冠状动脉吻合口数目、术前左心室舒张末容积(left ventricular enddiastolic volume,LVEDV)、二尖瓣后纵角有显著性差异(P均<0.05);(2)多因素Logistic回归分析显示,术中二尖瓣反流较术前变化程度越多,术后反流改善的可能性越高[术中反流较术前减少2个等级(OR=29.781, 95%CI:3.769~235.303)、减少1个等级(OR=15.934,95%CI:4.402~57.671)]。二尖瓣后纵角值越小(OR=0.917, 95%CI:0.846~0.994)、术前LVEDV值越低(OR=0.979,95%CI:0.967~0.991)、年龄越小(OR=0.855,95%CI:0.767~0.953),术后二尖瓣反流较术前改善的可能性越高;(3) ROC曲线分析显示,术中二尖瓣反流变化程度、术前LVEDV、二尖瓣后纵角、联合预测对术后二尖瓣反流改善均具有预测价值,其中术中二尖瓣反流变化程度及联合评估预测的曲线下面积(AUC)较显著,分别为0.763、0.888。结论:术中二尖瓣反流变化程度、术前LVEDV、二尖瓣后纵角对CABG术后IMR改善有一定预测价值,其中术中二尖瓣反流变化程度的预测价值较高。通过评估相关预测因素,可以识别同期二尖瓣手术获益更大的患者,减少CABG同期的二尖瓣手术率,降低手术风Objective:To investigate the change of mitral regurgitation degree in patients with ischemic mitral regurgitation(IMR)under general anesthesia during CABG,and to analyze its predictive value for mitral valve function improvement after CABG.Methods:A retrospective analysis was performed on 101 CABG patients with moderate or higher IMR.According to echocardiography of mitral regurgitation 1 month after surgery,the patients were divided into improved group(MR degree was at least one grade better than before surgery)and non-improved group.The preoperative routine data and the degree of mitral regurgitation before,during operation were analyzed to explore the predictive value for the improvement of mitral regurgitation after CABG.Results:①Of the 101 patients,65 showed improvement in IMR after surgery,while 36 did not.There was no significant difference in the degree of mitral regurgitation before operation between the improved group and the non-improved group(P>0.05).The change of mitral regurgitation degree during operation,intraoperative and postoperative mitral regurgitation degree were statistically different(all P<0.05).There were significant differences in age,number of coronary anastomosis during CABG,preoperative left ventricular end-diastolic volume(LVEDV)and mitral valve post leaf angle between the improved and non-improved groups(all P<0.05).②Multifactor regression analysis showed that the greater the change of mitral regurgitation degree during operation,the higher the probability of mitral regurgitation improvement[intraoperative regurgitation was reduced by 2 grades(OR=29.781,95%CI:3.769-235.303),1 grade(OR=15.934,95%CI:4.402-57.671)].The smaller the mitral valve post leaf angle(OR=0.917,95%CI:0.846~0.994),the lower the preoperative LVEDV value(OR=0.979,95%CI:0.967~0.991)and the younger the age(OR=0.855,95%CI:0.767~0.953),the higher the likelihood of postoperative mitral regurgitation improvement.③ROC curve analysis showed that the change of mitral regurgitation degree during operation,preoperative

关 键 词：冠状动脉旁路移植术 缺血性二尖瓣反流 超声心动图 

分 类 号：R54[医药卫生—心血管疾病]