發(fā)布時間：2018-11-16 17:11

【摘要】：目的：探討風(fēng)濕性二尖瓣重度狹窄伴小左室患者圍術(shù)期綜合治療后的臨床效果。方法：(1)、將風(fēng)濕性二尖瓣重度狹窄患者共計76例,按照左室大小分為小左室組(研究對象33例)以及非小左室組(研究對象43例)。(2)、收集所有患者入院時、圍術(shù)期以及術(shù)后1年隨訪時的臨床資料,包括：圍術(shù)期中心靜脈壓、血管活性藥物使用劑量、凝血制劑使用劑量,入院時及術(shù)后右心室射血分?jǐn)?shù)、左心室舒張末期容積指數(shù)、肺動脈收縮壓、肝功、六分鐘步行實驗距離、心功能分級和SF-36量表評分,術(shù)后早期并發(fā)癥發(fā)生率、機械通氣時間、監(jiān)護室入住時間和術(shù)后住院時間,術(shù)后口服華法林劑量、再住院率、血栓栓塞率、死亡率等各項臨床指標(biāo)。(3)、將各組患者術(shù)前與術(shù)后資料進行對比,明確各組圍術(shù)期綜合治療效果；并分析兩組患者術(shù)前以及術(shù)后改善情況的差異。結(jié)果：(1)、入院時小左室組中心靜脈壓明顯高于非小左室組,右心室射血分?jǐn)?shù)明顯低于非小左室組,差異具有統(tǒng)計學(xué)意義(P0.05),且小左室組肝功損傷程度較非小左室組嚴(yán)重；(2)、小左室組治療后肝功較入院時有所改善,但術(shù)后予以“冷沉淀”治療的患者數(shù)量仍明顯多于非小左室組；(3)、兩組患者術(shù)后中心靜脈壓較入院時均發(fā)生顯著降低,右心室射血分?jǐn)?shù)均明顯上升(P0.05),兩組間無明顯差異；手術(shù)對患者的肺動脈高壓改善均非常明顯,同時,術(shù)后霧化吸入“萬他維”(吸入用伊洛前列素溶液)5天組,較未吸入組肺動脈收縮壓可有明顯降低(P0.05)。術(shù)后早期,小左室組維持合適抗凝強度所需華法林劑量明顯少于非小左室組(P0.05)。(4)、小左室組術(shù)后機械通氣時間、監(jiān)護室入住時間較非小左室組明顯延長,肺部并發(fā)癥發(fā)生率增加。(5)、術(shù)后隨訪發(fā)現(xiàn),肺動脈高壓患者的肺動脈收縮壓均較入院顯著改善(P0.05)；兩組患者肝功、再住院率、血栓栓塞率、死亡率、六分鐘步行實驗距離和心功能分級均無明顯差異；小左室組左心室舒張末期容積指數(shù)相比入院時有顯著升高(P0.05),而且,與非小左室組間已無明顯差異；小左室組維持合適的凝血酶原時間(PT)所需服用的華法林劑量與非小左室組之間無明顯差異。小左室組患者與非小左室組患者術(shù)后生活質(zhì)量均可得到顯著提升,兩組患者之間無顯著差異。結(jié)論：風(fēng)濕性二尖瓣重度狹窄伴小左室的患者術(shù)前狀況較非小左室患者差,手術(shù)風(fēng)險大。圍術(shù)期處理難度高,但經(jīng)過圍術(shù)期的合適處理,術(shù)后恢復(fù)良好,各項指標(biāo)的恢復(fù)程度與非小左室組患者無顯著差異。
[Abstract]:Objective: to investigate the clinical effect of perioperative comprehensive treatment in patients with severe rheumatic mitral stenosis and small left ventricle. Methods: (1) 76 patients with severe rheumatic mitral stenosis were divided into small left ventricular group (33 cases) and non-small left ventricular group (43 cases). (2) according to left ventricular size. The clinical data of perioperative period and 1 year follow-up, including: perioperative central venous pressure, dosage of vasoactive drugs, dosage of coagulation preparation, right ventricular ejection fraction at admission and postoperative, left ventricular end-diastolic volume index, right ventricular ejection fraction, left ventricular end-diastolic volume index, Pulmonary artery systolic blood pressure, liver function, 6-minute walking distance, cardiac function grading and SF-36 scale score, incidence of early postoperative complications, time of mechanical ventilation, time of admission and hospitalization after operation, dosage of warfarin after operation. Rehospitalization rate, thromboembolism rate, mortality rate and other clinical indicators. (3) compare the preoperative and postoperative data of patients in each group, determine the effect of perioperative comprehensive treatment in each group; The difference of preoperative and postoperative improvement between the two groups was analyzed. Results: (1) on admission, the central venous pressure in the small left ventricular group was significantly higher than that in the non-small left ventricular group, and the right ventricular ejection fraction was significantly lower than that in the non-small left ventricular group (P0.05). The degree of liver function injury in the small left ventricle group was more serious than that in the non-small left ventricular group. (2) the liver function of the small left ventricular group was improved after treatment, but the number of patients treated with "cryoprecipitation" after operation was significantly higher than that of the non-small left ventricular group. (3) after operation, the central venous pressure (CPP) in the two groups was significantly lower than that in the hospital, and the right ventricular ejection fraction (RVEF) was significantly increased (P0.05), but there was no significant difference between the two groups. At the same time, the pulmonary arterial systolic pressure in the 5-day atomized group (inhaled with iloprostatin solution) was significantly lower than that in the non-inhaled group (P0.05). At the early stage of operation, the dose of warfarin needed to maintain proper anticoagulant intensity in the small left ventricular group was significantly lower than that in the non-small left ventricular group (P0.05). (4). The mechanical ventilation time and the stay time of the monitor unit in the small left ventricular group were significantly longer than those in the non-small left ventricular group. The incidence of pulmonary complications increased. (5) the pulmonary arterial systolic pressure in patients with pulmonary hypertension was significantly improved than that in patients with pulmonary hypertension (P0.05). There was no significant difference in liver function, rehospitalization rate, thromboembolism rate, mortality, 6-minute walking distance and cardiac function grading between the two groups. The left ventricular end-diastolic volume index in the small left ventricular group was significantly higher than that in the admission group (P0.05), and there was no significant difference between the small left ventricular group and the non-small left ventricular group. There was no significant difference in the dosage of warfarin between the small left ventricular group and the non-small left ventricular group in maintaining a proper prothrombin time (PT). The quality of life in the small left ventricular group and the non-small left ventricular group was significantly improved, but there was no significant difference between the two groups. Conclusion: the preoperative condition of patients with severe rheumatic mitral stenosis with small left ventricle is worse than that of non-small left ventricle patients. Perioperative treatment was difficult, but after proper perioperative treatment, the postoperative recovery was good. There was no significant difference in the degree of recovery between the non-small left ventricular group and the non-small left ventricular group.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.2

【參考文獻】

相關(guān)期刊論文 前1條

1 盧荔紅;關(guān)瑞錦;吳志勇;陳斌;陳新敬;蔣輝;;先天性心臟病并發(fā)重度肺動脈高壓介入封堵聯(lián)合伐地那非的應(yīng)用研究[J];臨床心血管病雜志;2012年07期

，

本文編號：2336117