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二尖瓣成形术治疗感染性心内膜炎合并二尖瓣关闭不全的中长期疗效 被引量:2

Mid-long term outcomes of mitral valve reconstruction for infective endocarditis with mitral insufficiency
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摘要 目的探讨二尖瓣成形术(mitral valvuloplasty,MVP)治疗感染性心内膜炎(infective endocarditis,IE)合并二尖瓣关闭不全(mitral regurgitation,MR)的中长期疗效。方法2009年6月至2016年11月,选取复旦大学附属中山医院心外科55例MVP治疗IE合并MR的患者作为观察组,47例二尖瓣置换术(mitral valve replacement,MVR)治疗IE合并MR的患者作为对照组,两组IE患者均单纯累及二尖瓣。回顾分析两组患者围术期资料并比较中长期疗效。结果观察组与对照组比较,术前性别、年龄、心功能等临床资料差异无统计学意义。观察组术后总住院时间短于对照组[(7.24±2.32)天vs.(9.93±2.63)天,P=0.003],体外循环时间、主动脉阻断时间、术后辅助通气时间、术后ICU住院时间、围术期输红细胞量、术后24 h引流量差异无统计学意义。对照组围术期死亡1例,观察组0例,两组患者围术期并发症发生率、死亡率差异无统计学意义。随访11~119个月,平均(43±27)个月,总随访率91%。随访期间观察组2例患者因MVP后二尖瓣狭窄伴关闭不全行MVR,对照组再次二尖瓣手术0例。两组再次二尖瓣手术发生率分别为4.0%和0,差异无统计学意义(P=0.543)。随访期间,观察组华法林抗凝并发症0例,对照组3例,发生率分别为0和7.0%,差异无统计学意义(P=0.059),两组患者均无复发、无死亡。多因素回归分析发现二尖瓣瓣膜损害、术者经验影响手术方式。结论MVP治疗IE合并MR围术期未显著影响手术安全性,中长期疗效明显,对于二尖瓣结构未严重破坏且术者具有较丰富的二尖瓣成形经验,推荐MVP。 Objective To investigate the mid-long term efficacy of mitral valvuloplasty(MVP)in the treatment of infective endocarditis(IE)with mitral regurgitation(MR).Methods From Jun 2009 to Nov 2016,55 patients with IE combined with mitral MR were treated by MVP in the Department of Cardiology,Zhongshan Hospital,Fudan University,which were selected as observation group,47 patients with IE complicated with MR were treated by mitral valve replacement(MVR),which were used as the control group.Both groups of IE patients simply involved mitral valve.The perioperative data of the two groups were retrospectively analyzed and the mid-long term curative effects were compared.Results There was no significant difference in clinical data such as gender,age and cardiac function between the observation group and the control group.The total hospital stay of the observation group was(7.24±2.32)days,which was shorter than that of the control group(9.93±2.63)days(P=0.003),There was no significant differences in CPB time,aorta blocking time,postoperative auxiliary ventilation time,postoperative ICU stay time,perioperative red blood cell volume and postoperative drainage 24 h.One case died in the control group,and no cases died in the observation group.There was no significant difference in the incidence of perioperative complications and mortality between the two groups.The patients were followed up for 11-119 months,with an average of(43±27)months,and the total follow-up rate was 91%.During the follow-up period,2 patients in the observation group underwent MVR due to mitral stenosis and insufficiency after MVP,and 0 patients in the control group underwent mitral valve operation again.The incidence of mitral valve re-operation in the two groups were 4.0%and 0 respectively,there was no significant difference between the two groups(P=0.543).During the follow-up period,there was 0 patients in the observation group and 3 patients in the control group with warfarin anticoagulation complications in the two groups.The incidence rates were 0 and 7.0%,respectively,with no significant difference(P=0.059).In addition,there was no recurrence and death in the two groups.Multivariate regression analysis showed that mitral valve damage and operator experience affected the mode of operation.Conclusion In the perioperative period,MVP for IE complicated with MR does not significantly affect the safety of the operation.It has obvious curative effect in the medium and long term.MVP is recommended if mitral valve structure has no serious damage and the operator has rich mitral valvuloplasty technology.
作者 钟玉斌 夏利民 钱松屹 徐德民 宋凯 ZHONG Yu-bin;XIA Li-min;QIAN Song-yi;XU De-min;SONG Kai(Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University(Xiamen Branch),Xiamen 361015,Fujian Province,China;Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Cardiovascular Disease Institute,Shanghai 200032,China)
出处 《复旦学报(医学版)》 CAS CSCD 北大核心 2023年第4期534-539,548,共7页 Fudan University Journal of Medical Sciences
基金 厦门市科技计划指导性项目(3502Z20199031)。
关键词 感染性心内膜炎(IE) 二尖瓣成形术(MVP) 二尖瓣关闭不全(MR) 中长期疗效 infective endocarditis(IE) mitral valvuloplasty(MVP) mitral regurgitation(MR) mid-long term outcomes
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