CAJ | 학술논문

目的：探讨保留二尖瓣瓣叶及瓣下结构二尖瓣置换的临床经验和治疗效果。方法以2009年1月至2012年12月在我院行保留二尖瓣瓣叶及瓣下结构的480例二尖瓣置换患者为观察组，二尖瓣瓣叶全部切除二尖瓣置换的350例患者为对照组。统计分析两组患者术前、术后6个月和12个月的Tei指数、Z指数、左心室射血分数(LVEF)和右心室射血分数(RVEF)。结果观察组患者手术成功率为98.3%，术后6个月和12个月患者的Tei指数、Z指数、LVEF、RVEF逐渐好转，术后12个月各项指标测量值均优于术后6个月的测量值，差异有统计学意义(P<0.05)。Tei指数与Z指数、LVEF、RVEF负相关，Z指数、LVEF、RVEF两两正相关，且各指标相关性分析|r|<1且≠0具有统计学意义。术后6个月观察组患者的Tei指数、Z指数、LVEF、RVEF明显优于对照组，差异均有统计学意义(P<0.05)。结论保留二尖瓣瓣叶及瓣下结构二尖瓣置换术适用于大多数二尖瓣病变患者，对于术后左、右心功能的改善及远期生活质量的提高有重要的意义。
목적：탐토보류이첨판판협급판하결구이첨판치환적림상경험화치료효과。방법이2009년1월지2012년12월재아원행보류이첨판판협급판하결구적480례이첨판치환환자위관찰조，이첨판판협전부절제이첨판치환적350례환자위대조조。통계분석량조환자술전、술후6개월화12개월적Tei지수、Z지수、좌심실사혈분수(LVEF)화우심실사혈분수(RVEF)。결과관찰조환자수술성공솔위98.3%，술후6개월화12개월환자적Tei지수、Z지수、LVEF、RVEF축점호전，술후12개월각항지표측량치균우우술후6개월적측량치，차이유통계학의의(P<0.05)。Tei지수여Z지수、LVEF、RVEF부상관，Z지수、LVEF、RVEF량량정상관，차각지표상관성분석|r|<1차≠0구유통계학의의。술후6개월관찰조환자적Tei지수、Z지수、LVEF、RVEF명현우우대조조，차이균유통계학의의(P<0.05)。결론보류이첨판판협급판하결구이첨판치환술괄용우대다수이첨판병변환자，대우술후좌、우심공능적개선급원기생활질량적제고유중요적의의。
Objective To explore the clinical experience and therapeutic effect of mitral valve replacement with leaflet and subvalvular structures preserved. Methods Four hundred and eighty patients who underwent mitral valve replacement with leaflet and subvalvular structures preserved in our hospital from January 2009 to December 2012 were se-lected as observation group, and 350 patients undergoing total mitral valve replacement were enrolled as control group. Tei index, Z index, left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) were compared between the two groups preoperatively, 6 months and 12 months after surgery. Results The success rate of operation reached 98.3%. Tei index, Z index, LVEF and RVEF showed improvement 6 months and 12 months after surgery, and the indexes 12 months after surgery were significantly better than those 6 months after surgery (P<0.05). Tei index was found negative-ly correlated with Z index, LVEF and RVEF. There were positive correlations between Z index, LVEF and RVEF, with the correlation coefficient|r|<1 and≠0. Tei index, Z index, LVEF and RVEF 6 months after surgery in the observation group were significantly better than those of the control group (P<0.05). Conclusion Mitral valve replacement with leaflets and subvalvular structures preserved can apply to most patients with mitral valve disease. It has important implications for pro-moting left and right heart function, as well as improving long-term life quality.