胸腔镜下行二尖瓣关闭不全成形术患者围术期指标改善及临床预后的研究

Improvement of perioperative indexes and clinical prognosis of patients with mitral regurgitation after thoracoscopic mitral valvuloplasty

目的:随访研究胸腔镜下行二尖瓣关闭不全成形术患者围术期指标改善及临床预后.方法:随机选取2018年12月至2020年5月,我院二尖瓣关闭不全患者90例,随机分为胸腔镜下行二尖瓣成形术组(胸腔镜组,n=45)和正中开胸二尖瓣成形术组(正中开胸组,n=45)两组,分析两组患者的手术创伤指标、恢复指标、血流动力学参数、并发症发生情况、镇痛药使用情况、二尖瓣成形术治疗效果.结果:与正中开胸组相比,胸腔镜组手术时间、关胸时间、ICU停留时间、引流管拔除时间均短于正中切口组(P<0.05),且切口长度较短(P<0.05),术中出血量和术后引流量均减少(P<0.05);两组体外循环时间、主动脉阻断时间、辅助时间无显著性差异(P>0.05).胸腔镜组患者术后较术前的LAD、LVEDD、LVESD、LVEDV、LVESV、LVEF、二尖瓣瓣口面积降低幅度与正中开胸组之间差异不显著(P>0.05).胸腔镜组术后并发症(4.4%)低于正中开胸组(8.8%)(P<0.05).胸腔镜组术后镇痛药使用率(28.9%)低于正中开胸组(100%)(P<0.05).胸腔镜组术后3个月二尖瓣轻度+反流发生率(4.4%)与正中开胸组(4.4%)比较,差异无统计学意义(P>0.05);胸腔镜组术后6个月二尖瓣轻度+反流发生率(6.7%)与正中开胸组(4.4%)比较,差异无统计学意义(P>0.05).结论:胸腔镜下行二尖瓣成形术对二尖瓣关闭不全患者围术期指标改善效果显著,近期临床预后不劣于正中开胸组.

Objective:To follow up and study the improvement of perioperative indexes and clinical prognosis of patients with mitral regurgitation after thoracoscopic mitral valvuloplasty.Methods:Ninety patients with mitral regurgitation in our hospital from December 2018 to May 2020 were randomly divided into two groups:thoracoscopic mitral valvuloplasty group(thoracoscopic group,n=45)and median thoracotomy mitral valvuloplasty group(median thoracotomy group,n=45).The surgical trauma index,postoperative recovery in-dex,hemodynamic parameters,postoperative complications,the use of postoperative analgesics and the thera-peutic effect of mitral valvuloplasty were statistically analyzed.Results:Compared with the median thoracotomy group,the operation time,chest closure time,ICU stay time and drainage tube removal time in the thoracoscopy group were shorter than those in the median incision group(P<0.05).The incision length was shorter(P<0.05),and the intraoperative blood loss and postoperative drainage decreased(P<0.05),but there was no significant difference in cardiopulmonary bypass time,aortic clamping time and auxiliary time be-tween the two groups(P>0.05).There was no significant difference in the decrease of LAD,LVEDD,LVESD,LVEDV,LVESV,LVEF and MVA between the thoracoscopic group and the median thoracotomy group(P>0.05).Postoperative complications in the thoracoscopic group(4.4%)were lower than those in the median thoracotomy group(8.8%)(P<0.05).The utilization rate of postoperative analgesics in the thoraco-scopic group(28.9%)was lower than that in the median thoracotomy group(100%)(P<0.05).There was no significant difference in the incidence of mild mitral regurgitation between thoracoscopic group(4.4%)and median thoracotomy group(4.4%)3 months after operation(P>0.05).Six months after operation,there was no significant difference in the incidence of mild mitral regurgitation between the thoracoscopic group(6.7%)and the median thoracotomy group(4.4%)(P>0.05).Conclusions:The improvement effect of thoracoscopic mitral valvuloplasty on the perioperative indexes of patients with mitral regurgitation was better than that of the median thoracotomy group,and the short-term clinical prognosis was not worse than that of the median thoracot-omy group.