机械瓣膜置换术对心脏瓣膜病患者瓣膜功能、心功能及心肌损伤的影响研究  

Mechanical Valve Replacement for Improving Valve Function,Cardiac Function,and Myocardial Protection in Patients with Valvular Heart Disease

作　　者：郑雄 王消防 张臻 杨博 刘磊 ZHENG Xiong;WANG Xiaofang;ZHANG Zhen;YANG Bo;LIU Lei(Department of Cardiovascular Surgery,Fuyang People's Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]安徽省阜阳市人民医院心脏大血管外科,安徽阜阳236000

出　　处：《转化医学杂志》2024年第10期1681-1684,共4页Translational Medicine Journal

基　　金：阜阳市卫生健康委科研项目(FY2021-031)。

摘　　要：目的探讨分析机械瓣膜置换术对心脏瓣膜病患者瓣膜功能、心功能及心肌损伤的影响。方法本研究回顾性分析2020年12月至2023年6月阜阳市人民医院收治的心脏瓣膜病患者103例为研究对象,对所有患者实施机械瓣膜置换术治疗。比较手术结束时、术后3个月心房颤动患者窦性心律转复率,术前及术后3 d白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、同型半胱氨酸、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB)及N末端B型脑钠肽前体(NT-proBNP)水平,术前及术后1年左心房内径(LAD)、左心室舒张末期内径(LVEDD)、射血分数(EF)变化,统计术后并发症发生率。结果75例心房颤动患者术后3个月窦性心律转复率[24.00%(18/75)]显著高于手术结束时[10.67%(8/75)](P<0.05)。术后3 d,103例患者IL-6、TNF-α、同型半胱氨酸、cTnI、CK-MB、NT-proBNP水平均低于术前(P<0.05)。术后1年,103例患者LAD、LVEDD显著低于术前(P<0.05),EF明显高于术前(P<0.05)。术后103例患者中出现牙龈出血3例,脑出血1例,皮下黏膜出血2例,脑梗死1例,并发症总发生率为6.80%(7/103),且患者用药后得到缓解。结论机械瓣膜置换术治疗心脏瓣膜病患者效果显著,不仅可有效提升患者的窦性心律转复率,抑制IL-6、TNF-α水平,还可降低同型半胱氨酸水平,改善心功能,加强心肌保护,且并发症发生率低,安全性高。Objective To investigate the effects of mechanical valve replacement on valve function,cardiac function,and myocardial protection in patients with valvular heart disease.Methods This retrospective study analyzed 103 patients with valvular heart disease treated at Fuyang People's Hospital from December 2020 to June 2023 All patients underwent mechanical valve replacement.The sinus rhythm restoration rate was analyzed of patients with atrial fibrillation at the end of surgery and 3 months postoperatively.Levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),homocysteine,cardiac troponin I(cTnI),creatine kinase-MB(CK-MB),and N-terminal pro-Btype natriuretic peptide(NT-proBNP)were compared preoperatively and 3 days postoperatively.Left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),and ejection fraction(EF)were evaluated preoperatively and 1 year postoperatively.Postoperative complications were recorded.Results The sinus rhythm restoration rate of 75patients with atrial fibrillation at 3 months postoperatively(24.00%,18/75)was significantly higher than that at the end of surgery(10.67%,8/75)(P<0.05).Three days postoperatively,IL-6,TNF-α,homocysteine,cTnI,CK-MB,and NTproBNP levels were significantly lower than their preoperative levels(P<0.05).At 1 year postoperatively,LAD and LVEDD were significantly reduced compared to preoperative levels(P<0.05),while EF was significantly increased(P<0.05).Postoperative complications included 3 cases of gingival bleeding,1 case of cerebral hemorrhage,2 cases of subcutaneous mucosal bleeding,and 1 case of cerebral infarction,with an overall incidence of 6.80%(7/103).Symptoms were alleviated after appropriate treatment.Conclusion Mechanical valve replacement provides significant therapeutic benefits for patients with valvular heart disease,including improving sinus rhythm restoration rates,reducing IL-6,TNF-α,and homocysteine levels,enhancing cardiac function,and strengthening myocardial protection.The procedure has a low complication rate and high saf

关 键 词：机械瓣膜置换术 人工心脏瓣膜 心脏瓣膜疾病 瓣膜功能 心功能 心肌保护 

分 类 号：R654.27[医药卫生—外科学]