体外循环下胸腔镜二尖瓣置换术治疗风湿性心脏病的临床效果  

Clinical Effect of Thoracoscopic Mitral Valve Replacement Under Extracorporeal Circulation in Treatment of Rheumatic Heart Disease

作　　者：宋宜升 殷生忱 薛继阳 姜建杰[1] SONG Yisheng;YIN Shengchen;XUE Jiyang;JIANG Jianjie(Zhejiang University School of Medicine the First Affiliated Hospital,Hangzhou,Zhejiang 310003)

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310003

出　　处：《智慧健康》2024年第35期38-41,共4页Smart Healthcare

摘　　要：目的探讨体外循环下胸腔镜二尖瓣置换术治疗风湿性心脏病的临床效果。方法选取2021年1月—2023年12月在本院心外科治疗的240例风湿性心脏病患者随机分为对照组和观察组,每组120例。其中,对照组采用体外循环下正中开胸二尖瓣置换术,观察组采用体外循环下胸腔镜二尖瓣置换术,对比两组的各项手术指标、心功能及心肌酶谱、并发症。结果两组体外循环时间对比,差异无统计学意义(P>0.05),观察组升主动脉阻断时间长于对照组,但术中出血量、术后辅助呼吸时间、术后24 h胸腔引流量、ICU停留时间、住院时间均少于对照组(P<0.05);观察组术后3 d的LVEF高于对照组,CK-MB、cTnI、CRP低于对照组(P<0.05);观察组二尖瓣反流、肺部感染、房颤、低心排血量等并发症发生率低于对照组(P<0.05)。结论体外循环下胸腔镜二尖瓣置换术治疗风湿性心脏病的临床效果显著,虽在一定程度上延长了体外循环时间及升主动脉阻断时间,但创伤减少,出血量少,术后并发症发生率低,心肌损伤程度轻,心功能恢复更好。Objective To investigate clinical effect of thoracoscopic mitral valve replacement under extracorporeal circulation in treatment of rheumatic heart disease.Methods The paper chose 240 patients with rheumatic heart disease in Cardiology Department of our hospital from January 2021 to December 2023,and divided them into two groups randomly.The control group was treated with mid thoracic mitral valve replacement surgery under extracorporeal circulation,while the observation group with thoracoscopic mitral valve replacement under extracorporeal circulation.Surgical indicators,cardiac function,myocardial enzyme spectrum and complications were compared between two groups.Results The extracorporeal circulation time between two groups was comparable(P>0.05).The observation group had longer aortic occlusion time than the control group,but intraoperative blood loss,postoperative assisted breathing time,postoperative 24-hour thoracic drainage volume,ICU stay and length of stay was less than the control group(P<0.05).The LVEF of the observation group was higher than the control group on postoperative day 3,while CK-MB,cTnI and CRP was lower than the control group(P<0.05).Incidence of complications including mitral regurgitation,pulmonary infection,atrial fibrillation and low cardiac output of the observation group was lower than the control group(P<0.05).Conclusion Thoracoscopic mitral valve replacement under extracorporeal circulation can achieve significant clinical effect for rheumatic heart disease.Although it prolongs extracorporeal circulation time and ascending aorta occlusion time to some certain extent,it can reduce trauma,bleeding,with low incidence of postoperative complications,mild myocardial injury and better cardiac function recovery.

关 键 词：风湿性心脏病 体外循环 胸腔镜二尖瓣置换术 临床效果 

分 类 号：R65[医药卫生—外科学]