本文選題：左房折疊術(shù)　切入點：二尖瓣置換　出處：《遵義醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察二尖瓣置換同期行左心房折疊術(shù)后患者圍手術(shù)期心臟功能的變化,總結(jié)該類患者圍手術(shù)期治療經(jīng)驗,以期為該類患者的術(shù)后治療提供指導(dǎo)。方法:回顧性分析2015年1月到2016年12月在我院胸心血管外科行二尖瓣置換(MVR)并三尖瓣成形術(shù)和二尖瓣置換并三尖瓣成形同期行左房折疊術(shù)(LAP)患者的臨床資料,共176例,其中符合入選條件的病例共42例。根據(jù)患者是否同期行左房折疊術(shù)分為對照組和同期行LAP組各21例,對照組僅行二尖瓣置換并三尖瓣成形術(shù),同期行LAP組在行二尖瓣置換并三尖瓣成形術(shù)時同期行左房折疊術(shù)。觀察分析其升主動脈阻斷時間(min)、體外循環(huán)時間(min)、術(shù)后ICU呼吸機輔助呼吸時間(h)、術(shù)后ICU治療時間(h)、術(shù)后住院時間(天)、術(shù)后當(dāng)天及術(shù)后3天血管活性藥物評分(VIS),術(shù)前及出院前心胸比(C/T)、左心房內(nèi)徑、左心室射血分?jǐn)?shù)(LVEF)、左心室短軸縮短率(LVFS)。結(jié)果:1.同期行LAP組與對照組病人術(shù)前一般狀況無差異。2.升主動脈阻斷時間、體外循環(huán)時間、術(shù)后呼吸機輔助呼吸時間、術(shù)后ICU治療時間對照組分別為53±12(min)、98±28(min)、28±19(h)、61±34(h),同期行LAP組分別為65±14(min)、108±26(min)、36±23(h)、72±38(h),兩組比較均有差異(P0.01)。3.術(shù)后住院天數(shù)對照組為12.63±4.11(天)、同期行LAP組為12.52±3.29(天),兩組比較無差異(P0.05)。4.術(shù)后當(dāng)天、第1天、第2天VIS評分對照組分別為15.28±4.41、12.42±4.01、8.26±3.11,同期行LAP組分別為19.68±6.32、18.42±5.72、11.32±3.64,兩組比較均有差異(P0.01);術(shù)后第3天VIS評分對照組為8.02±3.32、同期行LAP組為7.82±2.96,兩組比較無差異(P0.05)。5.術(shù)后左心房內(nèi)徑對照組為69±11(mm)、同期行LAP組為62±8(mm),兩組比較有差異(P0.01)。6.術(shù)后C/T對照組為0.66±0.04、同期行LAP組為0.59±0.03,兩組比較有差異(P0.05)。7.術(shù)后LVEF值對照組為59±4.6(%)、同期行LAP組為65±3.2(%),兩組比較有差異(P0.05);術(shù)后LVFS值對照組為33±2.9(%)、同期行LAP組為37±2.8(%),兩組比較有差異(P0.05)。結(jié)論:二尖瓣置換三尖瓣成形術(shù)同期行左房折疊術(shù),可顯著減小術(shù)后左心房內(nèi)徑和C/T,明顯縮小左心房,減輕GLA對周圍器官組織的壓迫,改善圍手術(shù)期GLA患者的心功能。左心房折疊術(shù)可能加重心臟損傷、短暫影響心功能,術(shù)后3天內(nèi)需要較多、較大劑量血管活性藥物支持治療,同時需要適當(dāng)延長呼吸機輔助呼吸時間及ICU治療時間,但經(jīng)圍手術(shù)期治療心功能能夠較快恢復(fù)。
[Abstract]:Objective: to observe the perioperative changes of cardiac function in patients undergoing mitral valve replacement and left atrial folding, and to summarize the experience of perioperative treatment in patients with mitral valve replacement. Methods: from January 2015 to December 2016, mitral valve replacement (MVR) and tricuspid valvuloplasty combined with tricuspid valvuloplasty and tricuspid valvuloplasty were performed in our hospital from January 2015 to December 2016. Clinical data of patients undergoing left atrial folding (LAP), The patients were divided into two groups: control group (n = 21) and LAP group (n = 21). The control group was treated with mitral valve replacement and tricuspid valvuloplasty. In LAP group, mitral valve replacement and tricuspid valvuloplasty were performed simultaneously with left atrial folding. The time of ascending aorta occlusion, cardiopulmonary bypass, ICU ventilator assisted respiration and ICU treatment were observed and analyzed. Postoperative hospitalization time (day and day), vasoactive drug score (Vis) on the day of operation and 3 days after operation, heart and chest ratio before and before discharge, left atrial diameter, left atrial diameter, left atrium diameter, left atrium diameter, left atrium diameter, left atrial diameter, left atrium diameter, left atrium diameter, Left ventricular ejection fraction (LVEF), left ventricular short axis shortening rate (LVEF) and left ventricular shortening rate (LVFS). Results: there was no significant difference in preoperative general status between LAP group and control group. 2. Time of ascending aorta occlusion, time of cardiopulmonary bypass, time of ventilator assisted respiration after operation. The duration of postoperative ICU treatment in the control group was 53 鹵12 minutes, 98 鹵28 minutes and 28 鹵19 minutes, respectively, and that in the LAP group was 65 鹵14 minutes, 108 鹵26 minutes, 36 鹵23 minutes, 72 鹵38 minutes, respectively. The postoperative hospitalization days were 12.63 鹵4.11 days in the control group and 12.52 鹵3.29 days in the LAP group, respectively. There was no difference between the two groups on the first day after operation, and there was no significant difference between the two groups on the first day after operation. On the second day, the VIS score of the control group was 15.28 鹵4.41 鹵4.01 鹵4.01 鹵8.26 鹵3.11, and that of the LAP group was 19.68 鹵6.32 鹵5.72 鹵11.32 鹵3.64, respectively. The VIS score of the control group was 8.02 鹵3.32 on the 3rd day after operation, and that of the LAP group was 7.82 鹵2.96. There was no significant difference in the internal diameter of left atrium between the two groups. The difference between the two groups was found between the two groups (P < 0.01). The C / T control group was 0.66 鹵0.04, and the LAP group was 0.59 鹵0.03, there was significant difference between the two groups. The LVEF value was 59 鹵4.6 in the control group and 65 鹵3.2 in the LAP group, respectively, and there was a significant difference between the two groups in the postoperative LVFS value in the control group (P 0.05). The value of mitral valve replacement was 33 鹵2.9 and that of LAP group was 37 鹵2.8. Conclusion: mitral valve replacement tricuspid valvuloplasty and tricuspid valve replacement were performed simultaneously with left atrial folding, and there was a significant difference between the two groups. It can significantly reduce the left atrial diameter and C / T, reduce the pressure of GLA on peripheral organs and tissues, and improve the cardiac function of patients with GLA during perioperative period. During the 3 days after operation, a large dose of vasoactive drugs should be used to support the treatment, and the time of ventilator assisted breathing and ICU should be prolonged properly. However, the cardiac function could recover quickly in the perioperative period.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.2

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