不同保留瓣下结构行二尖瓣置换术的对比分析

Comparative analysis of mitral valve replacement with different flaps

目的对比不同保留瓣下结构行二尖瓣置换术的效果，为临床手术提供参考。方法选取从2014年2月至2015年4月在本院心脏外科接受二尖瓣置换术治疗的患者84例为观察对象。按照不同手术方法分为观察组与对照组各42例，对照组为二尖瓣置换术中保留二尖瓣后叶及瓣下结构的患者，而观察组为二尖瓣置换术中保留二尖瓣全瓣叶及瓣下结构的患者，对比两组手术效果。结果观察组机械通气时间、升压药物使用时间均显著短于对照组（P〈0．05）；治疗前两组左心室功能指标对比差异无统计学意义，治疗后观察组LVEDD、LVESD均显著低于对照组，而LVEF显著高于对照组（P〈0．05）；治疗后观察组心功能I级人数占比显著高于对照组，而心功能Ⅳ级人数占比显著低于对照组（P〈0．05）；观察组术后并发症发生率为9．52％（4／42），显著低于对照组的26．19％（11／42）（P〈0．05）。结论行二尖瓣置换术中保留二尖瓣全瓣叶及瓣下结构临床效果明显，可有效改善患者心功能，降低并发症发生率，具有较好的安全性。

Objective To compare the effect of mitral valve replacement with different flaps and to provide reference for clinical operation. Methods From February 2014 to April 2015, 84 patients undergoing mitral valve replacement surgery in our hospital were selected. The patients were divided into observation group and control group according to different operation methods, 42 cases in each group. The patients in the control group were treated with mitral valve replacement with preservation of the posterior leaflet and the mitral valve, while the patients in the observation group were treated with mitral valve replacement with preservation of the mitral valve leaflet and the valve flap. The effect of the two groups were compared. Results The time of mechanical ventilation and the time of pressor drug use in the observation group were significantly shorter than those in the control group （P〈0.05）. There were no statistically significant differences in left ventricular function indicators between the two groups before treatment; after treatment, LVEDD and LVESD in the observation group were significantly lower than those in the control group, LVEF was significantly higher than that in the control group （P〈0.05）. After treatment, the rate of cardiac function grade I in the observation group was significantly higher than that in the control group, and the rate of cardiac function grade IV was significantly lower than that in the control group （P〈0.05）. The incidence of postoperative complications in the observation group was 9.52% （4/42）, significantly lower than that in the control group [26.19% （11/42）] （P〈0.05）. Conclusion The clinical effect of mitral valve replacement with the preservation of the mitral valve leaflet and the valve flap structure is obvious, which can effectively improve the cardiac function and reduce the occurrence of complications.