二尖瓣置换同期行左心房折叠术在围手术期的观察与处理

发布时间：2018-03-14 11:40

本文选题：左房折叠术　切入点：二尖瓣置换　出处：《遵义医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察二尖瓣置换同期行左心房折叠术后患者围手术期心脏功能的变化,总结该类患者围手术期治疗经验,以期为该类患者的术后治疗提供指导。方法:回顾性分析2015年1月到2016年12月在我院胸心血管外科行二尖瓣置换(MVR)并三尖瓣成形术和二尖瓣置换并三尖瓣成形同期行左房折叠术(LAP)患者的临床资料,共176例,其中符合入选条件的病例共42例。根据患者是否同期行左房折叠术分为对照组和同期行LAP组各21例,对照组仅行二尖瓣置换并三尖瓣成形术,同期行LAP组在行二尖瓣置换并三尖瓣成形术时同期行左房折叠术。观察分析其升主动脉阻断时间(min)、体外循环时间(min)、术后ICU呼吸机辅助呼吸时间(h)、术后ICU治疗时间(h)、术后住院时间(天)、术后当天及术后3天血管活性药物评分(VIS),术前及出院前心胸比(C/T)、左心房内径、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)。结果:1.同期行LAP组与对照组病人术前一般状况无差异。2.升主动脉阻断时间、体外循环时间、术后呼吸机辅助呼吸时间、术后ICU治疗时间对照组分别为53±12(min)、98±28(min)、28±19(h)、61±34(h),同期行LAP组分别为65±14(min)、108±26(min)、36±23(h)、72±38(h),两组比较均有差异(P0.01)。3.术后住院天数对照组为12.63±4.11(天)、同期行LAP组为12.52±3.29(天),两组比较无差异(P0.05)。4.术后当天、第1天、第2天VIS评分对照组分别为15.28±4.41、12.42±4.01、8.26±3.11,同期行LAP组分别为19.68±6.32、18.42±5.72、11.32±3.64,两组比较均有差异(P0.01);术后第3天VIS评分对照组为8.02±3.32、同期行LAP组为7.82±2.96,两组比较无差异(P0.05)。5.术后左心房内径对照组为69±11(mm)、同期行LAP组为62±8(mm),两组比较有差异(P0.01)。6.术后C/T对照组为0.66±0.04、同期行LAP组为0.59±0.03,两组比较有差异(P0.05)。7.术后LVEF值对照组为59±4.6(%)、同期行LAP组为65±3.2(%),两组比较有差异(P0.05);术后LVFS值对照组为33±2.9(%)、同期行LAP组为37±2.8(%),两组比较有差异(P0.05)。结论:二尖瓣置换三尖瓣成形术同期行左房折叠术,可显著减小术后左心房内径和C/T,明显缩小左心房,减轻GLA对周围器官组织的压迫,改善围手术期GLA患者的心功能。左心房折叠术可能加重心脏损伤、短暂影响心功能,术后3天内需要较多、较大剂量血管活性药物支持治疗,同时需要适当延长呼吸机辅助呼吸时间及ICU治疗时间,但经围手术期治疗心功能能够较快恢复。
[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 卤12 minutes, 98 卤28 minutes and 28 卤19 minutes, respectively, and that in the LAP group was 65 卤14 minutes, 108 卤26 minutes, 36 卤23 minutes, 72 卤38 minutes, respectively. The postoperative hospitalization days were 12.63 卤4.11 days in the control group and 12.52 卤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 卤4.41 卤4.01 卤4.01 卤8.26 卤3.11, and that of the LAP group was 19.68 卤6.32 卤5.72 卤11.32 卤3.64, respectively. The VIS score of the control group was 8.02 卤3.32 on the 3rd day after operation, and that of the LAP group was 7.82 卤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 卤0.04, and the LAP group was 0.59 卤0.03, there was significant difference between the two groups. The LVEF value was 59 卤4.6 in the control group and 65 卤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 卤2.9 and that of LAP group was 37 卤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.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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