周围体外循环辅助下左心瓣膜置换术后重度三尖瓣关闭不全外科治疗

Surgical treatment of severe tricuspid regurgitation after left heart valve replacement assisted by extracorporeal circulation

目的评价周围体外循环辅助下左心瓣膜置换术后重度三尖瓣关闭不全外科治疗效果。方法随机抽取2016年4月至2017年2月我院住院患者中符合研究要求的患者74例,平均分为三尖瓣置换术组、三尖瓣成形术组,比较2组患者临床指标、生化指标、术后并发症发生情况。结果三尖瓣置换术组体外循环时间、升主动脉阻断时间、呼吸机辅助呼吸时间、重症监护病房(ICU)住院时间、累积住院时间显著低于三尖瓣成形术组,差异具有统计学意义(P<0.05);置换术组在出院时和出院后1个月血浆白蛋白、结合胆红素、血红蛋白含量与成形术组差异有统计学意义(P<0.05);置换术组并发症恶性心律失常、肾功能不全、切口愈合不良患者数量远远低于形成术组患者数量,差异具有统计学意义(P<0.05)。结论周围体外循环辅助下左心瓣膜置换术后重度三尖瓣关闭不全外科治疗效果肯定,有助于提高患者生存质量。

Objective To evaluate surgical treatment of severe tricuspid regurgitation after left ventricular valve replacement assisted by peripheral extracorporeal circulation.Methods A total of 74 inpatients in our hospital from April 2016 to February 2017 were randomly selected, and randomly divided into two groups： tricuspid valve replacement group and tricuspid annuloplasty group. Statistical difference of clinical indicators, biochemical indexes and postoperative complications between the two groups was analyzed.Results In the tricuspid valve replacement group, the cardiopulmonary bypass time, ascending aorta blockade time, ventilator-assisted breathing time, ICU length of stay, and cumulative length of stay were significantly lower than those in the tricuspid valve angioplasty group. The differences were statistically significant. The plasma albumin, conjugated bilirubin, and hemoglobin levels in the replacement group were significantly different from those in the angioplasty group at discharge and at 1 month after discharge and differences were statistically significant. The number of patients with malignant arrhythmia, renal insufficiency, and poor incision healing in the replacement group was much lower than the number of patients in the formation group, and the differences were statistically significant.Conclusion The effect of surgical treatment of severe tricuspid regurgitation after left ventricular valve replacement assisted by extracorporeal circulation is positive and can help improve the quality of life of patients.