接受不同二尖瓣替换术患者术后早期心功能的变化

Early Postoperative Heart Function Variation of patients underwent Different Mitral Valve Replacement

为了比较常规二尖瓣替换术（ＭＶＲ）与保留瓣下结构的二尖瓣替换术（ＭＶＲＰ）对患者术后早期心功能的影响，对３４例单纯风湿性二尖瓣病变患者于术前经右股静脉导入Ｓｗａｎ－Ｇａｎｚ导管，术后４、２４、４８小时分别测定其血流动力学指标。结果：接受ＭＶＲ患者的术后肺动脉平均压（ＭＰＡＰ）、肺血管阻力（ＰＶＲ）和肺毛细血管嵌压（ＰＣＷＰ）均明显高于接受ＭＶＲＰ者；而心搏指数（ＳＶＩ）、心脏指数（ＣＩ）和左心室每搏作功指数（ＬＶＳＷＩ）则低于接受ＭＶＲＰ者。ＭＶＲＰ患者术后早期心功能曲线更趋向正常Ｆｒａｎｋ－Ｓｔａｒｌｉｎｇ容量曲线，而ＭＶＲ患者则明显右移。提示ＭＶＲ损害左心功能，使其代偿能力降低；ＭＶＲＰ则最大程度地保护左室泵功能，更有利于患者术后心功能的恢复。

To compare the effect of the routine mitral valve replacement(MVR) with MVRwith preservation of the mitral complex(MVRP)on patients' early postoperative heart function 34 patients suffered from pure rheumatic mitral valve lesion were directed Swan Ganz catheter by right femoral vein before operation,whose hemodynamic index were measured respectively after 4、24 and 48 hours postoperatively The results show that mean pulmonary artery pressure (MPAP),pulmonary vessel resistance (PVR) and pulmonary capillary wedge pressure (PCWP)of patients underwent MVR were far more higher than those underwent MVRP,but stroke volume index(SVI)、cardial index(CI)and left ventricular stroke work index(LVSWI)were markedly lower than the latter The early postoperatively heart function curve of the patients underwent MVRP more tend to normal Frank Starling volume curve,but that of the patients underwent MVR shift right overtly It shows that MVR damages left heart function and declines its compensated capability However MVRP protects left ventricular pump competence to most degree which benefit for recovery of the postoperative heart function