二尖瓣成形术联合综合干预对风湿性二尖瓣病变的治疗效果分析

Analysis of the therapeutic effect of mitral valvuloplasty combined with comprehensive intervention in patients with rheumatic mitral valve disease

目的 探讨二尖瓣成形术联合综合干预治疗风湿性二尖瓣病变的临床效果。方法 选取2020年1月至2021年8月南京医科大学第一附属医院收治的572例风湿性二尖瓣病变患者,采用随机数字表法分为置换组和成形组,每组286例。置换组采用二尖瓣置换术进行治疗,成形组采用二尖瓣成形术进行治疗,两组术后均随访6个月,并于围术期给予综合干预。比较两组患者的围术期指标,术前及术后6个月的心功能、生活质量,以及随访期间的并发症发生情况。结果 与置换组比较,成形组术中出血量更低,住院时间更短,体外循环时间、手术时间更长,差异有显著性(P<0.05)。术前两组跨瓣压差、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、二尖瓣最大反流速度、左心房内径(left atrial diameter,LAD)、左心室射血分数(left ventricular ejection fraction,LVEF)及左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)比较差异均无显著性(P>0.05);术后6个月时,两组跨瓣压差、LVEDD均明显低于术前,且置换组明显低于成形组,LVEF明显高于术前,且成形组明显高于置换组,LVESD、LAD均明显低于术前,且成形组明显低于置换组,差异有显著性(P<0.05);术后6个月时两组二尖瓣最大反流速度均明显低于术前(P<0.05),但组间比较差异无显著性(P>0.05)。术前两组健康调查量表36各维度得分比较差异无显著性(P>0.05);术后6个月两组健康调查量表36各维度得分均明显高于术前,且成形组明显高于置换组,差异有显著性(P<0.05)。随访期间,成形组并发症发生率为8.39%,明显低于置换组的21.68%,差异有显著性(P<0.05)。结论 二尖瓣成形术联合综合干预可明显改善风湿性二尖瓣病变患者的围术期情况,提高患者的心功能及生活质量,安全性较高。

Objective To explore the clinical effect of mitral valvuloplasty combined with comprehensive intervention in the treatment of rheumatic mitral valve disease.Method A total of 572 patients with rheumatic mitral valve disease were selected and were divided into the replacement group and the plastic group with 286 cases in each group by random number table method.The replacement group was treated with mitral valve replacement,and the plastic group was treated with mitral valve replacement Both groups followed up for 6 months,and comprehensive intervention was given in the perioperative period.The perioperative indicators,cardiac function,quality of life before and 6 months after operation and complications during the followed up period of two groups were compared.Result Compared with the replacement group,the intraoperative blood loss in the plastic group was lower,the the times of hospital stay was shorter,and the times of cardiopulmonary bypass and operation were longer(P<0.05).There was no significant difference in preoperative cross valve pressure difference,left ventricular end diastolic diameter(LVEDD),maximum mitral regurgitation velocity,left atrial diameter(LAD),left ventricular ejection fraction(LVEF),and left ventricular end systolic diameter(LVESD)between the two groups(P>0.05);6 months after operation,the transvalvular pressure difference and LVEDD of two group decreased,the plastic group was higher;LVEF increased in the two groups,and the plastic group was higher;LVESD and LAD decreased in the both groups,and the plastic group was significantly lower than the replacement group,with a significant difference(P<0.05);at 6 months after operation,the maximum mitral regurgitation velocity in both groups was significantly lower than before operation(P<0.05),but there was no significant difference between the groups(P>0.05).There was no significant difference in the scores of the 36 dimensions of the preoperative health survey scale between the two groups(P>0.05);at 6 months after operation,the scores of both groups in all dimensions of the Health Survey Scale 36 were significantly higher than before operation,and the plastic group was significantly higher than the replacement group,with a significant difference(P<0.05).During the follow-up period,the incidence of complications in the plastic group was 8.39%,significantly lower than the 21.68%in the replacement group,with a significant difference(P<0.05).Conclusion Mitral valvuloplasty combined with comprehensive intervention coud significantly improve the perioperative indicators of patients with rheumatic mitral valve disease,and improve the cardiac function and quality of life,with high safety.