二尖瓣修复术治疗感染性心内膜炎所致二尖瓣反流患者

Mitral valve repairment for mitral regurgitation due to infective endocarditis

目的探讨二尖瓣修复及置换术对感染性心内膜炎所致二尖瓣反流患者的疗效。方法选取2014年1月至2016年1月于淄博市中心医院就诊的126例感染性心内膜炎所致二尖瓣反流患者为研究对象,根据治疗过程中手术方式不同分为研究组和对照组(各63例),研究组患者采取二尖瓣修复术进行治疗,对照组患者采取二尖瓣置换术进行治疗。详细记录入组患者的气管插管时间、入住重症加强护理病房(ICU)时间、感染发生率、手术患者病死率、住院天数、住院花费等;记录患者心脏超声检查结果:左心室射血分数、左心室舒张末期直径、左心室收缩末期直径、左心房直径及二尖瓣反流得分,并记录随访指标。结果与对照组患者相比,研究组患者气管插管时间[(16.48±8.06)h]、入住ICU时间[(2.12±0.86)h]、术后病死率(1.59%)、住院时间[(22.46±10.34)d]、栓塞发生率(4.76%)以及住院花费[(10.63±3.57)万元]差异均有统计学意义(t=1.35、P=0.04,t=3.68、P=0.02,χ~2=4.67、P=0.01,t=4.03、P=0.01,χ~2=1.69、P=0.04,t=3.06、P=0.03);研究组患者术后左心室射血分数[(49.06±10.24)%]、左心房直径[(43.25±8.98)mm]和二尖瓣反流得分[(1.12±0.31)分]均小于对照组患者,左心室舒张末期直径[(52.46±7.42)mm]和左心室收缩末期直径[(39.70±8.09)mm]均大于对照组患者,差异均有统计学意义(t=1.23、2.84、3.89、1.34、2.01,P=0.04、0.02、0.01、0.03、0.02)。随访显示,研究组患者左心室射血分数[(61.38±8.61)%]大于对照组患者(t=5.31、P=0.01),左心室舒张末期直径[(48.69±9.57)mm]和随访病死率(4.76%)均小于对照组,差异有统计学意义(t=3.24、P=0.02,χ~2=2.91,P=0.03)。单因素方差分析显示入住ICU时间、插管时间和心功能衰竭史均为感染性心内膜炎患者手术死亡危险因素(t=2.34、P=0.01,t=1.09、P=0.03,χ~2=1.61、P=0.02)。结论二尖瓣修复术对感染性心内膜炎所致二尖瓣反流疗效和预后较好,能够缩短患者住院时间和降低入院费用。

Objective To investigate the effect of mitral valve repairment and replacement on mitral regurgitation caused by infective endocarditis.Methods Total of 126 patients with mitral regurgitation caused by infective endocarditis were selected from January 2014 to January 2016 in Zibo Central Hospital, who were divided into study group and control group (63 cases in each group) according to different operation methods.Patients in the study group were treated with mitral valve repairment and patients in the control group were treated with mitral valve replacement.The periods of endotracheal intubation and intensive care unit (ICU) hospitalization,the incidence of infection,the fatality rate,the period and the cost of hospitalization of the 126 patients were recorded in detail,respectively.The results of echocardiography in patients for left ventricular ejection fraction,left ventricular end-diastolic diameter,left ventricular endsystolic diameter,left atrial diameter and mitral regurgitation score were recorded,respectivly.Results Tracheal intubation period [(16.48 ± 8.06) h],ICU hospitalization period [(2.12 ± 0.86) h],postoperative mortality rate (1.59%),hospitalization period [(22.46 ± 10.34) d],incidence of embolism (4.76%) and hospitalization cost [(10.63 ± 3.57) ten thousand yuan] of the study group were lower than those of the control group,with significant differences (t = 1.35,P = 0.04;t = 3.68,P = 0.02;χ^2 = 4.67,P = 0.01;t = 4.03,P = 0.01;χ^2 = 1.69,P = 0.04;t = 3.06,P = 0.03).The left ventricular ejection fraction [(49.06 ± 10.24)%],left atrial diameter [(43.25 ± 8.98) mm] and mitral regurgitation score [(1.12 ± 0.31)] of patients in study group were lower than those in the control group,while left ventricular end-diastolic diameter [(52.46 ± 7.42) mm] and left ventricular end-systolic diameter [(39.70 ± 8.09) mm] of patients in study group were larger than those of control group,all with significant differents (t = 1.23,2.84,3.89,1.34,2.01;P = 0.04,0.02,0.01,0.03,0.02). Following-up showed that left ventricular ejection fraction of patients in the study group (61.38 ± 8.61)% was higher than that of the control group (t = 5.31,P = 0.01);but left ventricular end-diastolic diameter [(48.69 ± 9.57) mm] and follow-up mortality (4.76%) were lower than those of the control group,with significant differences (t = 3.24,P = 0.02;χ^2 = 2.91,P = 0.03).Univariate analysis of variance showed that ICU hospitalization period,intubation period and history of heart failure were all risk factors of operative death for patients with infective endocarditis (t = 2.34,P = 0.01;t = 1.09,P = 0.03;χ^2 = 1.61,P = 0.02).Conclusions Mitral valve repairment is effective in the treatment of mitral regurgitation caused by infective endocarditis, which could shorten the hospitalization period and reduce the cost of mitral valve regurgitation.