中国医药
中國醫藥
중국의약
China Medicine
2015年
10期
1418-1422
,共5页
曹劝省%王永生%张俊伟%石辛格
曹勸省%王永生%張俊偉%石辛格
조권성%왕영생%장준위%석신격
二尖瓣置换术%体外循环%保留二尖瓣及瓣下结构%安全性%可行性
二尖瓣置換術%體外循環%保留二尖瓣及瓣下結構%安全性%可行性
이첨판치환술%체외순배%보류이첨판급판하결구%안전성%가행성
Mitral valve replacement%Cardiopulmonary bypass%Mitral valve and valve structures reserved%Safety%Feasibility
目的 探讨体外循环下行二尖瓣置换术中保留二尖瓣及瓣下结构的安全性及可行性.方法 选取2006年1月至2014年6月河南科技大学第一附属医院收治行体外循环二尖瓣置换术的患者105例,依据随机数字表法分为A、B、C3组,每组35例.A组患者行二尖瓣置换术切除全部二尖瓣叶及瓣下结构;B组患者行二尖瓣置换术保留全部二尖瓣后叶及瓣下结构;C组患者行二尖瓣置换术保留部分二尖瓣后叶及瓣下结构.对3组患者手术前后超声心动图变化情况、血流动力学指标及并发症发生情况进行统计学分析.结果 术后10d和术后3个月,B组、C组患者的左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、左心室部分缩短(LVFS)、左心室射血分数(LVEF)与A组比较,差异均有统计学意义[术后10 d:(41 ±5)、(38 ±5) mm比(45±5)mm,(59 ±6)、(53±7) mm比(61 ±6) mm,(3l±4)％、(34±4)％比(29±4)％,(61±6)％、(62±7)％比(58±6)％;术后3个月:(43±5)、(35 ±5) mm比(42±5)rmm,(61 ±5)、(52 ±4) mm比(59±5)mm,(33±3)％、(36±3)％比(32±3)％,(62±5)％、(66±6)％比(59±5)％,均P＜0.05];术后48 h时,A组患者的平均肺动脉压(MPAP)、肺血管阻力(PVR)明显高于B组、C组[(5.8±0.6)kPa比(4.4±0.9)、(4.5±0.9)kPa;(50±13)kPa·s/L比(34±10)、(36±16) kPa·s/L],心脏指数和左心室每搏功指数(LVSWI)明显低于B组、C组[(2.6±0.5)L/(min·m2)比(3.2±0.4)、(3.1 ±0.5)L/(min·m2);(1.9±0.5)mJ/m2比(3.7±0.9)、(3.3 ±0.4) mJ/m2],差异有统计学意义(P＜0.05);同一时点3组患者的肺动脉楔压(PCWP)比较[术后＜4h时,A、B、C组PCWP分别为(2.2±0.6)、(1.6±0.6)、(1.4±0.4)kPa;术后24 h时分别为(2.4±0.4)、(1.7±0.4)、(1.6 ±0.4)kPa;术后48 h时分别为(2.5±0.4)、(1.5±0.3)、(1.6±0.5) kPa],差异均有统计学意义(P＜0.05).术后24 h时,A组的LVSWI低于B组,差异有统计学意义[(2.2±0.7)mJ/m2比(3.1±1.0) mJ/m2,P ＜0.05].A组患者的术后早期并发症发生率和病死率均明显高于B组、C组[31.4％ (11/35)比17.1％ (6/35)、14.3％ (5/35);11.4％ (4/35)比5.7％ (2/35)、2.9％(1/35)],差异有统计学意义(P＜0.05).结论 体外循环下行二尖瓣置换术中保留二尖瓣及瓣下结构安全可行.
目的 探討體外循環下行二尖瓣置換術中保留二尖瓣及瓣下結構的安全性及可行性.方法 選取2006年1月至2014年6月河南科技大學第一附屬醫院收治行體外循環二尖瓣置換術的患者105例,依據隨機數字錶法分為A、B、C3組,每組35例.A組患者行二尖瓣置換術切除全部二尖瓣葉及瓣下結構;B組患者行二尖瓣置換術保留全部二尖瓣後葉及瓣下結構;C組患者行二尖瓣置換術保留部分二尖瓣後葉及瓣下結構.對3組患者手術前後超聲心動圖變化情況、血流動力學指標及併髮癥髮生情況進行統計學分析.結果 術後10d和術後3箇月,B組、C組患者的左心室收縮末期內徑(LVESD)、左心室舒張末期內徑(LVEDD)、左心室部分縮短(LVFS)、左心室射血分數(LVEF)與A組比較,差異均有統計學意義[術後10 d:(41 ±5)、(38 ±5) mm比(45±5)mm,(59 ±6)、(53±7) mm比(61 ±6) mm,(3l±4)％、(34±4)％比(29±4)％,(61±6)％、(62±7)％比(58±6)％;術後3箇月:(43±5)、(35 ±5) mm比(42±5)rmm,(61 ±5)、(52 ±4) mm比(59±5)mm,(33±3)％、(36±3)％比(32±3)％,(62±5)％、(66±6)％比(59±5)％,均P＜0.05];術後48 h時,A組患者的平均肺動脈壓(MPAP)、肺血管阻力(PVR)明顯高于B組、C組[(5.8±0.6)kPa比(4.4±0.9)、(4.5±0.9)kPa;(50±13)kPa·s/L比(34±10)、(36±16) kPa·s/L],心髒指數和左心室每搏功指數(LVSWI)明顯低于B組、C組[(2.6±0.5)L/(min·m2)比(3.2±0.4)、(3.1 ±0.5)L/(min·m2);(1.9±0.5)mJ/m2比(3.7±0.9)、(3.3 ±0.4) mJ/m2],差異有統計學意義(P＜0.05);同一時點3組患者的肺動脈楔壓(PCWP)比較[術後＜4h時,A、B、C組PCWP分彆為(2.2±0.6)、(1.6±0.6)、(1.4±0.4)kPa;術後24 h時分彆為(2.4±0.4)、(1.7±0.4)、(1.6 ±0.4)kPa;術後48 h時分彆為(2.5±0.4)、(1.5±0.3)、(1.6±0.5) kPa],差異均有統計學意義(P＜0.05).術後24 h時,A組的LVSWI低于B組,差異有統計學意義[(2.2±0.7)mJ/m2比(3.1±1.0) mJ/m2,P ＜0.05].A組患者的術後早期併髮癥髮生率和病死率均明顯高于B組、C組[31.4％ (11/35)比17.1％ (6/35)、14.3％ (5/35);11.4％ (4/35)比5.7％ (2/35)、2.9％(1/35)],差異有統計學意義(P＜0.05).結論 體外循環下行二尖瓣置換術中保留二尖瓣及瓣下結構安全可行.
목적 탐토체외순배하행이첨판치환술중보류이첨판급판하결구적안전성급가행성.방법 선취2006년1월지2014년6월하남과기대학제일부속의원수치행체외순배이첨판치환술적환자105례,의거수궤수자표법분위A、B、C3조,매조35례.A조환자행이첨판치환술절제전부이첨판협급판하결구;B조환자행이첨판치환술보류전부이첨판후협급판하결구;C조환자행이첨판치환술보류부분이첨판후협급판하결구.대3조환자수술전후초성심동도변화정황、혈류동역학지표급병발증발생정황진행통계학분석.결과 술후10d화술후3개월,B조、C조환자적좌심실수축말기내경(LVESD)、좌심실서장말기내경(LVEDD)、좌심실부분축단(LVFS)、좌심실사혈분수(LVEF)여A조비교,차이균유통계학의의[술후10 d:(41 ±5)、(38 ±5) mm비(45±5)mm,(59 ±6)、(53±7) mm비(61 ±6) mm,(3l±4)％、(34±4)％비(29±4)％,(61±6)％、(62±7)％비(58±6)％;술후3개월:(43±5)、(35 ±5) mm비(42±5)rmm,(61 ±5)、(52 ±4) mm비(59±5)mm,(33±3)％、(36±3)％비(32±3)％,(62±5)％、(66±6)％비(59±5)％,균P＜0.05];술후48 h시,A조환자적평균폐동맥압(MPAP)、폐혈관조력(PVR)명현고우B조、C조[(5.8±0.6)kPa비(4.4±0.9)、(4.5±0.9)kPa;(50±13)kPa·s/L비(34±10)、(36±16) kPa·s/L],심장지수화좌심실매박공지수(LVSWI)명현저우B조、C조[(2.6±0.5)L/(min·m2)비(3.2±0.4)、(3.1 ±0.5)L/(min·m2);(1.9±0.5)mJ/m2비(3.7±0.9)、(3.3 ±0.4) mJ/m2],차이유통계학의의(P＜0.05);동일시점3조환자적폐동맥설압(PCWP)비교[술후＜4h시,A、B、C조PCWP분별위(2.2±0.6)、(1.6±0.6)、(1.4±0.4)kPa;술후24 h시분별위(2.4±0.4)、(1.7±0.4)、(1.6 ±0.4)kPa;술후48 h시분별위(2.5±0.4)、(1.5±0.3)、(1.6±0.5) kPa],차이균유통계학의의(P＜0.05).술후24 h시,A조적LVSWI저우B조,차이유통계학의의[(2.2±0.7)mJ/m2비(3.1±1.0) mJ/m2,P ＜0.05].A조환자적술후조기병발증발생솔화병사솔균명현고우B조、C조[31.4％ (11/35)비17.1％ (6/35)、14.3％ (5/35);11.4％ (4/35)비5.7％ (2/35)、2.9％(1/35)],차이유통계학의의(P＜0.05).결론 체외순배하행이첨판치환술중보류이첨판급판하결구안전가행.
Objective To analyze the safety and feasibility of mitral valve replacement with mitral valve and valve structures reserved under cardiopulmonary bypass.Methods Clinical data of 105 patients who underwent mitral valve replacement under cardiopulmonary bypass from January 2006 to June 2014 were enrolled and randomly divided into group A,B and C.During mitral valve replacement,the mitral valve and valve structures were removed in group A;these structures were reserved in group B and they were partly reserved in group C.The echocardiographic changes,hemodynamic parameters and postoperative complications were statistically analyzed.Results Ten days and 3 months after operation,the left ventricular end systolic diameter,left ventricular enddiastolic diameter,left ventricular fractional shortening and left ventricular ejection fraction in group B and group C were significantly improved compared with those in group A [10 days after operation:(41 ± 5),(38 ± 5) mm vs (45 ±5) mm,(59 ±6),(53 ±7) mm vs (61 ±6) mm,(31 ±4)％,(34 ±4) ％ vs (29 ±4) ％,(61 ±6)％,(62 ±7)％ vs (58 ±6) ％;3 months after operation:(43 ±5),(35 ±5) mm vs (42±5) mm,(61 ±5),(52 ±4) mm vs (59 ±5) mm,(33 ±3)％,(36±3)％ vs (32±3)％,(62±5)％,(66 ±6)％ vs (59 ±5)％](all P ＜0.05).The mean pressures of pulmonary artery and pulmonary vascular resistance were significantly higher and the cardiac index and left ventricular-stroke work index (LVSWI) were significantly lower in group A than those in group B and group C [(5.8 ±0.6) kPa vs (4.4 ±0.9),(4.5 ±0.9) kPa;(50 ± 13) kPa · s/L vs (34 ± 10),(36±16) kPa· s/L;(2.6 ±0.5) L/(min · m2) vs (3.2±0.4),(3.1 ±0.5) L/(min · m2);(1.9±0.5) mJ/m2 vs (3.7±0.9),(3.3 ±0.4) mJ/m2] (P ＜0.05);the pulmonary capillary wedge pressure (PCMP) 4,24 and 48 h after operation was significantly different among the three groups [4 h after operation:(2.2±0.6) kPavs (1.6±0.6) kPavs (1.4±0.4) kPa,24 h after operation:(2.4±0.4) kPavs (1.7±0.4) kPa vs (1.6 ± 0.4) kPa,48 h after operation:(2.5 ± 0.4) kPa vs (1.5 ± 0.3) kPa vs (1.6 ± 0.5) kPa](P ＜ 0.05);24 h after operation,the LVSWI in group A was significantly lower than that in group B [(2.2 ±0.7) mJ/m2 vs (3.1 ± 1.0) mJ/m2] (P ＜0.05).The incidence of early postoperative complications and mortality rate were significantly higher in group A compared with those in group B and group C [31.4％ (11/35) vs 17.1％ (6/35),14.3％ (5/35);11.4％ (4/35) vs 5.7％ (2/35),2.9％ (1/35)] (P ＜0.05).Conclusion Mitral valve replacement with mitral valve and valve structures reserved under cardiopulmonary bypass is safe and feasible.
