风湿性心脏病二尖瓣病变患者瓣膜替换术后肺功能的改变

Effect of Mitral Valve Replacement Surgery on Pulmonary Function in Patients With Rheumatic Mitral Valve Disease

目的：了解风湿性心脏病二尖瓣病变患者二尖瓣替换术（ＭＶＲ）后肺功能的改变。方法：观察２６例风湿性心脏病二尖瓣病变患者ＭＶＲ术前和术后３～１２个月的肺功能改变。结果：ＭＶＲ后３个月的肺功能与术前相比，无明显好转。术后６～１２个月，患者的各通气功能指标均有明显增加（Ｐ＜０．０５～Ｐ＜０．０１），但肺的一氧化碳弥散功能（ＤＬＣＯ）术后不但无增加，反而有下降的趋势。结论：ＭＶＲ术后３个月患者的肺功能与术前相比，无明显好转，可能与剖胸手术创伤有关。随着心功能的改善，术后６～１２个月，患者的通气功能逐渐改善，但ＤＬＣＯ并不增加，推测可能与患者术后肺泡毛细血管容量减少以及肺组织结构损害不可逆性改变有关。

Objective:To study the effect of mitral valve replacement surgery(MVR) on pulmonary function in patients with rheumatic mitral valve disease. Methods:Pulmonary function was assessed in 26 patients with rheumatic mitral valve diseases before and at varying intervals(3 to 12 months) after MVR. Results:The pulmonary function was not improved at 3 months after MVR compared with the preoperative pulmonary function.The pulmonary ventilative function was gradually improved at 6 months to 12 months after MVR( p <0.05～ p <0.01).The diffusing capacity(DLCO) showed no increase but tended to decrease instead. Conclusion:The pulmonary function was not improved at 3 months after MVR compared with that of preoperation due to the injury of thoracotomy.The pulmonary ventilative function was gradually improved with the improvement of heart function at 6 to 12 months after MVR.But the DLCO was not increased implying the decrease of pulmonary capillary blood volume after MVR and endurance of irreversible lung structural damage.