肺动脉瓣关闭不全23例外科治疗及文献复习

Early and mid-term outcomes of surgical pulmonary valve replacement in pulmonary valve insufficiency

目的:探究外科置换肺动脉瓣治疗肺动脉瓣关闭不全的术后早中期临床疗效。方法:回顾性分析2010-03-2016-07我院23例行肺动脉瓣置换术患者,比较患者手术前后主要临床指标,观察术后早中期临床疗效。结果:围手术期死亡1例,严重肺部感染2例,肾功能损害需透析治疗1例,22例患者治愈出院。置换肺动脉瓣生物瓣4例,置换肺动脉瓣机械瓣19例,置换机械瓣患者术后口服华法林抗凝治疗,INR控制目标在2~3。术后早期未出现主要出血事件及血栓形成事件。患者术前超声心动图与术后1个月、1年比较,右房、右室直径均显著缩小(P<0.05);左房直径、左室直径、肺动脉瓣峰速、左室短轴缩短率、左室射血分数手术前后无明显改变(P>0.05)。随访(41.3±31.8)个月,中期死亡1例,余患者心功能明显改善。结论:肺动脉瓣置换治疗肺动脉瓣关闭不全有较好的早中期效果,同期处理三尖瓣反流安全可靠。

Objective：To explore the early and mid-term outcomes of surgical pulmonary valve replacement in pulmonary incompetence.Method：In retrospective analysis from March 2010 to July 2016,23 patients had pulmonary valve replacement in our department.We compared several major clinical indicators preoperatively and postoperatively,and early and mid-term postoperative curative effects.Result：There were 1 case in perioperative death,2 cases in severe pulmonary infection,1 case in renal damage required dialysis treatment.The 22 patients were cured and left hospital alive.There were 4 cases in bioprosthetic valve replacement,19 cases in mechanical valve replacement.Oral warfarin postoperatively for mechanical valve replacement patients kept INR in 2-3.No major bleeding events and thrombosis events were diagnosed during hospital stay.Right atrium and right ventricular diameter were significantly reduced postoperatively（P〈0.05）.While left atrial diameter,left ventricular diameter,pulmonary valve peak velocity,left ventricular short axis reduced rate,left ventricular ejection fraction had no significant change postoperationly（P〈0.05）.Follow-up time was 41.3±31.8 months.There was 1 case in mid-term death.The rest cases were in heart function classⅠ-Ⅱ.Conclusion：Surgical pulmonary valve replacement in pulmonary insufficiency is safe and with satisfied early and mid-term effects.Repairing reguritation simultaneously is safe and reliable.