Bentall手术治疗升主动脉瘤合并主动脉瓣关闭不全的疗效及对患者心功能指标的影响

The effect of Bentall operation on ascending aorta aneurysm combined with aortic insufficiency and its effect on cardiac function index

目的通过分析Bentall手术治疗升主动脉瘤合并主动脉瓣关闭不全患者手术前后心功能指标的变化,以探讨其临床疗效。方法选取蚌埠医学院第一附属医院心脏外科2014年1月—2018年12月70例升主动脉瘤合并主动脉瓣关闭不全行Bentall手术患者的临床资料,观察手术疗效及治疗前、后心功能分级情况,观察相关超声指标及血清指标的差异。结果 70例患者均顺利完成手术,平均体外循环时间为(165.3±45.7)min,主动脉阻断时间为(98.3±26.4)min,围术期死亡率为8.57%,术后不良反应率为25.71%,术后93.75%的患者心功能分级恢复至Ⅰ～Ⅱ级。Bentall手术治疗前后患者心输出量(CO)、每搏量(SV)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、氨基末端B型利钠肽前体(NT-proBNP)、心脏型脂肪酸结合蛋白(H-FABP)、半乳糖凝集素-3(Galectin-3)比较差异具有统计学意义(均P<0.05)。结论 Bentall手术治疗升主动脉瘤合并主动脉瓣关闭不全的临床疗效较好,术后可明显改善患者心功能指标,是安全可行的方法。

Objective The clinical efficacy of the patients with ascending aortic aneurysm combined with aortic regurgitation before and after operation was analyzed by Bentall surgery. Methods From January 2014 to December 2018, 70 patients with ascending aortic aneurysm complicated with aortic valve insufficiency underwent Bentall operation in Cardiac Surgery Department of the First Affiliated Hospital of Bengbu Medical College were selected to observe the effect of operation and the grading of cardiac function before and after treatment, and to observe the differences of related ultrasound and serum indexes. Results All the 70 patients underwent successful operation, with an average cardiopulmonary bypass time(165.3±45.7) min, aortic occlusion time(98.3±26.4) min, perioperative mortality rate 4.29%, postoperative adverse reaction rate 25.71%, postoperative 93.75 The cardiac function of the patient was restored to grade Ⅰ-Ⅱ. Cardiac output(CO), stroke volume(SV), left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD) before and after Bentall surgery, amino terminal B-type natriuretic peptide precursor(NT-proBNP), cardiac fatty acid binding protein(H-FABP), galectin-3(Galectin-3). The difference was statistically significant(all P<0.05). Conclusion Bentall operation is a safe and feasible method for the treatment of ascending aortic aneurysm and aortic valve insufficiency.