心脏瓣膜种类选择对老年患者生活质量影响的临床对照研究

Impact of Choice of Prosthetic Heart Valves on Quality of Life for Elderly Patients after Mitral Valve Replacement:A Controlled Trial

目的评价65岁以上患者行二尖瓣置换术术后生活质量。方法采用诺丁汉(第一部分)健康调查问卷和杜克活动问卷形式,前瞻性地对北京安贞医院心脏外科单纯手术组行二尖瓣置换术的90例患者在术前、术后进行问卷调查,患者根据植入瓣膜类型分为生物瓣组和机械瓣组两组:每组各45例,其中男62例、女28例,年龄65～76(68.6±6.8)岁,合并高血压55例,2型糖尿病38例,全部患者均合并持续性心房颤动。全部患者均采用全身麻醉,建立体外循环,经房间沟处理二尖瓣。机械瓣采用连续缝合,不保留后瓣,生物瓣应用换瓣线间断缝合,术中常规保留部分后瓣。两组患者术中均应用双极射频笔消融双侧肺静脉及左心耳至透壁,左心耳均未予缝合或结扎处理。结果所有患者术后生活质量均较术前提高。术后6个月随访,两组患者生活质量差异无统计学意义。但术后1年起,生物瓣组患者的生活质量明显优于机械瓣组,而且机械瓣组术后3年生活质量较术后1年无明显改变,而生物瓣组生活质量提高程度仍然明显。结论老年患者行二尖瓣置换术后生活质量均有所提高。与置换机械瓣相比,置换生物瓣的老年患者远期获益可能更大。

Objective To evaluate postoperative quality of life （QOL） of patients aged over 65 after mitral valve replacement （MVR）. Methods Ninety patients aged over 65 undergoing MVR by the same surgical group in Department of Cardiovascular Surgery of Anzhen Hospital were prospectively enrolled in this study. There were 62 male and 28 female patients with their age of 65-76 （68.6±6.8 ）years. There were 55 patients with hypertension, 38 patients with type 2 diabetes, and all the patients had persistent atrial fibrillation. Nottingham Healthy Profile （NHP, Part I） and Duke Activity Status Index （ DASI ） were used to evaluate preoperative and postoperative QOL. According to the choice of prosthetic heart valves they received, all the patients were divided into two groups with 45 patients in each group： biological valve group and mech- anical valve group. All the patients received MVR via the interatrial groove approach under general anesthesia and cardiop- ulmonary bypass. Mechanical valve replacement was performed using continuous suture without preserving the posterior leaflet of the mitral valve. Biological valve replacement was performed using interrupted suture and some of the posterior leaflet of the mitral valve was routinely preserved. Patients in both groups underwent intraoperative bilateral pulmonary vein isolation and left atrial appendage ablation using a bipolar radiofrequency ablation device. The left atrial appendage was not excised or ligated. Results Postoperative QOL of all the patients was significantly better than preoperative QOL. There was no statistical difference in NHP and DASI at the 6th month after discharge between the 2 groups. But from the 1st year after discharge, QOL of the biological valve group was significantly better than that of the mechanical valve group. At the 3rd year after discharge, NHP and DASI of the mechanical valve group was not statistically different from those at the 1st year after discharge, but NHP and DASI of the biological valve group was significantly better than those at the 1 st year after discharge. Conclusions QOL of elderly patients are significantly improved after MVR. Patients who receive biological valve replacement may acquire better long-term QOL than patients who receive mechanical valve replacement.