完整保留二尖瓣及瓣下结构的二尖瓣置换术疗效观察

Observation of the curative effect of mitral valve replacement with whole preservation of mitral valve and subvalvular apparatus

目的观察完整保留二尖瓣及瓣下结构的二尖瓣置换术的治疗效果。方法风湿性二尖瓣疾病患者82例随机分为2组,观察组行完整保留二尖瓣及瓣下结构的二尖瓣置换术,对照组行保留二尖瓣后瓣的二尖瓣置换术,观察2组手术相关指标及心功能恢复情况。结果 2组患者的手术操作时间、升主动脉阻断时间以及心脏复跳时间比较均无显著性差异,观察组机械通气持续时间、ICU停留时间、血管活性药物使用时间比较均明显低于对照组(P均<0.05);术后3周时,观察组的E峰值、E/A比值、左心室舒张末期直径、左室射血分数均明显高于对照组(P均<0.05)。结论完整保留二尖瓣及瓣下结构的二尖瓣置换术能够在不影响升主动脉阻断时间以及心脏复跳时间的基础上,促进术后恢复,改善心功能,是治疗风湿性二尖瓣疾病安全有效的手术方式。

Objective It is to observe the curative effect of mitral valve replacement with whole preservation of mitral valve and subvalvular apparatus.Methods 82 patients with rheumatic bicuspid valve disease were randomly divided into 2 groups：the observation group was given mitral valve replacement with whole preservation of mitral valve and subvalvular apparatus,and the control group was given mitral valve replacement with preservation of subvalvular.The correlated operation indexes and recovery of cardiac function in both groups were observed.Results There was no significant difference in operation time,aortic cross-clamping time,and spontaneous returned heart beat between both groups,but duration of mechanical ventilation,ICU stay time,using time of vasoactive agents in observation group were obviously lower than that in control group（P 〈 0.05）.In 3 weeks after surgy,E peak value,E/A value,LVEDD,LVEF were significantly higher than that in control group （P 〈 0.05）.Conclusion Mitral valve replacement with whole preservation of mitral valve and subvalvular apparatus accelerate postoperative recovery,improve cardiac function without effect on aortic cross-clamping time and spontaneous returned heart beat,it is a effective and safe surgery for rheumatic bicuspid valve disease.