风湿性二尖瓣狭窄手术时机的选择对围术期的影响

Effect of the operative timing on patients with rheumatic mitral stenosis during the perioperative period

目的 探讨风湿性二尖瓣狭窄行瓣膜外科置换手术时机的选择对患者围术期的影响.方法 回顾性分析2012年1月至2013年12月在沈阳军区总医院心血管外科诊断为风湿性二尖瓣狭窄（MS）并行瓣膜置换的住院患者122例.根据术前心脏超声结果,按照二尖瓣瓣口面积（MVA）狭窄程度将患者分为三组,分别为轻度狭窄（＞1.5 cm^2）、中度狭窄（1.0-1.5 cm^2）和重度狭窄（＜1.0 cm^2）组.收集患者的相关临床资料,通过单因素和多因素Logistic回归分析手术时机的选择对各组患者围术期的影响.结果 全组患者均取得理想效果,心功能等级与术前相比有较大的提升,患者生活质量得到改善.住院期间死亡2例,其余患者出院时纽约心功能等级（NYHA）都达到Ⅰ～Ⅱ、Ⅱ级之间,甚至Ⅰ级.单因素分析显示患者的肺动脉压力（PASP）、左室舒张末容积、二尖瓣口面积、心胸比、ICU时间、呼吸机辅助时间、住院时间为风湿性二尖瓣狭窄围术期预后的影响因素,多因素Logistic回归分析显示三组患者的肺动脉压力、二尖瓣口面积为风湿性二尖瓣狭窄围术期预后的独立影响因素.结论 二尖瓣置换术（MVR）是治疗风湿性二尖瓣狭窄的有效方法.适时地手术时机可以提高患者的围术期效果,有助于及早的改善生活质量.患者早期就诊也应当是影响围术期预后的重要因素.适时地手术时机、早期就诊可提高患者的围术期生存优势.

Objective To investigate the effect of operation timing on patients with rheumatic mitral stenosis underwent valve replacement during perioperative period.Methods Retrospective analysis were performed on 122 cases diagnosed as rheumatic mitral stenosis （mitral stenosis,MS） underwent valve replacement,during January 2012 through December 2013 in the Department of Cardiovascular Surgery,General Hospital of Shenyang military region.According to the mitral valve area （mitral valve area,MVA） measured by echocardiography before operation,patients were respectively divided into three groups,mild stenosis （〉 1.5 cm^2）,moderate stenosis （1.0 - 1.5 cm^2）,and severe stenosis （〈 1.0 cm^2）.Through the single factor and multi-factor logistic regression analysis on all clinical data collected from patients,the effects of operation timing on patients were confirmed in perioperative period in each group.Results The results were satisfied in the group.Heart function was significantly raised compared to that before surgery,and the life quality of the patients was improved.Two cases died during hospitalization,New York Heart Association Functional Class （NYHA） reached between Ⅰ - Ⅱ,Ⅱ,perhaps Ⅰ for survival.Single factor analysis showed that the pulmonary arterial systolic pressure （pulmonary arterial systolic pressure,PASP）,left ventricular end diastolic volume,mitral valve area,cardiothoracic ratio,intensive care unit （ICU） staying,ventilator-assistant during hospitalization were influence factors on surgical opportunity of patients with rheumatic mitral stenosis and perioperative outcomes.Multivariate logistic regression analysis showed that pulmonary artery pressure and mitral valve orifice area were the independent influence factors on surgical timing by collecting perioperative outcomes in the groups.Conclusions Mitral valve replacement （mitral valve replacement,MVR） is an effective method in the treatment of rheumatic mitral stenosis.Timely operation can improve the prognosis of patients in the perioperative period,and help to improve the quality of life.Early treatment should be an important factor affecting the perioperative prognosis.Timely operation,early treatment may improve the patient＇s survival during perioperative period.