【摘要】：目的:心臟瓣膜病行二尖瓣置換和(或)主動脈瓣置換同期對繼發(fā)三尖瓣反流采取瓣膜成形術,對比采用Edwards MC3成形環(huán)和De Vega成形術治療三尖瓣反流的效果,并分析術后三尖瓣再次反流的影響因素。方法:選取至2015年1月至2016年3月在四川綿陽四0四醫(yī)院心臟大血管外科因心臟瓣膜病行二尖瓣置換和(或)主動脈瓣置換同期行三尖瓣成形術的患者共60例進行分析,根據(jù)隨機分組的原則,采用“信封法”分為兩組,其中一組為MC3成形環(huán)組,共計30例,另一組為De Vega縫線組,共計30例。收集所有患者入院時術前一般資料、NYHA心功能分級、超聲心動圖等相關觀察指標,手術相關指標,以及術后1周,術后3個月,術后6個月,術后1年心臟功能、超聲心動圖等相關指標,觀察患者術前、術后左室心臟功能、肺動脈收縮壓力、左心房室直徑、右心房室直徑、三尖瓣瓣環(huán)徑、三尖瓣反流程度變化情況,對比二尖瓣置換和(或)主動脈瓣置換同期行三尖瓣成形的效果。結(jié)果:兩組患者術前一般資料對比(P0.05,差異無統(tǒng)計學意義)。術前兩組患者的經(jīng)胸超聲心動圖在房室大小對比中(P0.05差異無統(tǒng)計學意義)。MC3成形環(huán)組與De Vega縫線組術前LVEF(%)分別為51.51±6.38與50.13±6.06,TV瓣環(huán)徑(mm)分別為45.57±8.85與45.40±8.27,三尖瓣反流程度分別為2.26±1.07,肺動脈收縮壓s PAP(mm Hg)分別為49.37±13.09與47.23±13.37,上述四組對比結(jié)果無差異(P0.05,差異無統(tǒng)計學意義)。兩組患者除三尖瓣成形手術外,余手術方式比較無差異(P0.05,差異無統(tǒng)計學意義)。兩組患者在手術時間、體外循環(huán)時間、升主動脈阻斷時間、術后呼吸機輔助時間、術后ICU停留時間、總住院時間對比結(jié)果無差異(P0.05,差異無統(tǒng)計學意義)。手術前后比較兩組患者NYHA心功能分級,兩組患者組內(nèi)比較,術后3個月、6個月、12個月都較術前好轉(zhuǎn)(P0.05,差異無統(tǒng)計學意義),術后1周心功能較術前比較稍差(P0.05,差異有統(tǒng)計學意義),主要是由于手術后心功能還未完全恢復所導致,術后同一時期對比兩組患者心功能分級無差異(P0.05,差異無統(tǒng)計學意義)。術后與隨訪期間MC3成形環(huán)組與De Vega縫線組的患者三尖瓣反流情況較術前均明顯好轉(zhuǎn),三尖瓣反流等級明顯改善(均為P0.05),術后1周、3個月、6個月、1年期間兩組患者間的三尖瓣反流等級無顯著的差異(P0.05)。MC3成形環(huán)組與De Vega縫合組術后1周、3個月、6個月、12個月的三尖瓣瓣環(huán)徑大小與術前比較,均明顯減小(P0.05),且無再次擴張病例。結(jié)論:治療左心瓣膜疾病伴功能性三尖瓣關閉不全主要同期采用三尖瓣成形術治療。De Vega縫合法治療繼發(fā)性三尖瓣關閉不全在近期可有效減少反流量,有效改善患者的NYHA心功能分級。Edwards MC3人工成形治療繼發(fā)性三尖瓣關閉不全在近期可有效改善三尖瓣反流,顯著提高患者心功能。使用Edwards MC3成形環(huán)與De Vega成形術兩種方式后的近期三尖瓣瓣環(huán)徑較術前均明顯縮小,恢復至正常大小,且固定穩(wěn)固,均無明顯的再次擴大。De Vega縫合法與Edwards MC3人工成形治療繼發(fā)性三尖瓣關閉不全的近期效果肯定,且兩者間無明顯差異,遠期效果有待進一步研究。為臨床工作中治療繼發(fā)性三尖瓣關閉不全提供臨床依據(jù)。
[Abstract]:AIM: To compare the effects of Edwards MC3 annuloplasty with De Vega annuloplasty in the treatment of secondary tricuspid regurgitation and analyze the influencing factors of postoperative tricuspid regurgitation. Sixty patients who underwent mitral valve replacement and/or aortic valve replacement and tricuspid valve plasty at the same time were analyzed. According to the principle of random grouping, the patients were divided into two groups by envelope method. One group was MC3 annulus plasty group (30 cases) and the other was De Vega suture group (30 cases). The general data, NYHA cardiac function grading, echocardiography and other related observation indicators, operation related indicators, and postoperative 1 week, 3 months, 6 months, 1 year postoperative cardiac function, echocardiography and other related indicators were collected. The left ventricular cardiac function, pulmonary artery systolic pressure, left ventricular systolic pressure, left ventricular systolic pressure were observed before and after operation. The effects of mitral valve replacement and/or aortic valve replacement with tricuspid valvuloplasty were compared. Results: The preoperative general data of the two groups were compared (P 0.05, no significant difference). The LVEF (%) of MC3 annuloplasty group and De Vega suture group were 51.51 (%) and 50.13 (%) respectively, the diameter of TV annulus (mm) were 45.57 (+ 8.85) and 45.40 (+ 8.27), the tricuspid regurgitation degree was 2.26 (+ 1.07), the pulmonary systolic pressure (SMHg) was 49.37 (+ 13.09) and 47.23 (+ 13.37), respectively. There was no significant difference between the two groups (P 0.05, no significant difference) except tricuspid valvuloplasty. The operation time, cardiopulmonary bypass time, ascending aorta occlusion time, postoperative ventilator assistance time, postoperative ICU stay time, total hospitalization time were compared between the two groups. Results There was no significant difference (P 0.05, no significant difference). The NYHA cardiac function of the two groups was compared before and after operation. The two groups were better than before operation at 3 months, 6 months and 12 months after operation (P 0.05, no significant difference). There was no significant difference in cardiac function between the two groups at the same time (P 0.05, no significant difference). Tricuspid regurgitation was significantly improved in MC3 ring group and De Vega suture group after operation and during follow-up, and tricuspid regurgitation was significantly improved in both groups (P 0.05). There was no significant difference in tricuspid regurgitation between the two groups (P 0.05). The size of tricuspid annulus in MC3 group and De Vega suture group decreased significantly after 1 week, 3 months, 6 months and 12 months (P 0.05), and there was no case of re-expansion. The treatment of secondary tricuspid regurgitation with De Vega suture can effectively reduce regurgitation and improve NYHA cardiac function classification in patients with secondary tricuspid regurgitation. The short-term results of Edwards MC3 and De Vega in the treatment of secondary tricuspid insufficiency were confirmed. There is no significant difference between them, and the long-term effect needs further study.
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2

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