体外循环下胸腔镜二尖瓣置换术治疗风湿性心脏病的临床效果

Clinical effect of thoracoscopic mitral valve replacement under extracorporeal circulation in the treatment of rheumatic heart disease

目的 探讨体外循环下胸腔镜二尖瓣置换术治疗风湿性心脏病的临床效果。方法 选取2018年2月至2020年12月我院收治的80例风湿性心脏病患者为研究对象,根据手术方式不同将其分为对照组和研究组,各40例。对照组行传统开胸二尖瓣置换术,研究组行胸腔镜下体外循环二尖瓣置换术。比较两组的手术及预后指标、炎性指标、心肌损伤指标、心功能指标、临床疗效。结果 研究组的体外循环时间、升主动脉阻断时间长于对照组,术中出血量、24 h胸腔引流量少于对照组,术后辅助呼吸时间、ICU住院时间短于对照组,差异具有统计学意义(P<0.05)。术后3 d,研究组的CRP、IL-6、IL-8、TNF-α水平低于对照组,差异具有统计学意义(P<0.05)。术后3 d,研究组的CK-MB、cTnI水平低于对照组,差异具有统计学意义(P<0.05)。术后5 d,研究组的LVEDD、LVESD、LAD小于对照组,LVEF高于对照组,差异具有统计学意义(P<0.05)。研究组的治疗总有效率为95.00%,高于对照组的80.00%,差异具有统计学意义(P<0.05)。结论 体外循环下胸腔镜二尖瓣置换术治疗风湿性心脏病的效果显著,可减少术中出血量、24 h胸腔引流量,缩短术后辅助呼吸时间、ICU住院时间,降低炎性指标及心肌损伤指标水平,改善心功能指标。

Objective To analyze the clinical effect of thoracoscopic mitral valve replacement under extracorporeal circulation in the treatment of rheumatic heart disease.Methods Eighty patients with rheumatic heart disease admitted in our hospital from February 2018 to December 2020 were selected as the research objects.The patients were divided into control group and study group according to different surgical methods,with 40 cases in each group.The control group received traditional thoracotomy mitral valve replacement,and the study group received thoracoscopic mitral valve replacement under extracorporeal circulation.The operation and prognosis indexes,inflammatory indexes,myocardial injury indexes,cardiac function indexes and clinical efficacy were compared between the two groups.Results The extracorporeal circulation time and aortic clamping time in the study group were longer than those in the control group,the amount of intraoperative bleeding and 24 h thoracic drainage volume were less than those in the control group,the postoperative auxiliary breathing time and ICU hospitalization time were shorter than those in the control group,and the differences were statistically significant(P<0.05).Three days after operation,CRP,IL-6,IL-8 and TNF-α levels in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Three days after operation,CK-MB and cTnI levels in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Five days after operation,LVEDD,LVESD and LAD in the study group were smaller than those in the control group,LVEF was higher than that in the control group,and the differences were statistically significant(P<0.05).The total effective rate of treatment in the study group was 95.00%,which was higher than 80.00% in the control group,and the difference was statistically significant(P <0.05).Conclusion Thoracoscopic mitral valve replacement under extracorporeal circulation in the treatment of rheumatic heart disease has a remarkable effect.It can reduce the amount of intraoperative bleeding and 24 h thoracic drainage volume,shorten the postoperative auxiliary breathing time and ICU hospitalization time,reduce the inflammatory indexes and myocardial injury indexes levels,and improve the cardiac function indexes.