左心瓣膜术后继发性三尖瓣反流再次行三尖瓣置换术的临床分析

发布时间：2018-04-29 10:15

本文选题：左心瓣膜手术 + 心脏瓣膜病　；参考：《上海交通大学学报(医学版)》2017年07期

【摘要】：目的·分析左心瓣膜术后三尖瓣置换术的围术期及中期结果,探讨继发性三尖瓣反流发病机制以及手术危险因素。方法·回顾性分析85例左心瓣膜术后行三尖瓣置换术患者的围术期临床资料及中期随访结果。根据人工瓣膜种类分2组,其中生物瓣组50例,机械瓣组35例;根据手术径路分2组,其中右前外侧切口组51例,正中切口组34例。结果·住院死亡7例(8.2%),其中住院早期死亡(术后30 d内)5例(5.9%),住院晚期死亡(术后30 d后)2例(2.4%),死亡原因均为术后严重右心功能衰竭及低心排血量。生物瓣组死亡率(4/50)与机械瓣组(3/35)比较,差异无统计学意义(χ~2=0.009,P=1.000);正中切口组死亡率(6/34)与右前外侧切口组(1/51)比较,差异有统计学意义(χ2=6.642,P=0.015)。随访74例(94.9%),随访时间(31.5±23.1)个月;中期死亡4例(5.4%),均为机械瓣组患者,其中心源性死亡3例,肠癌晚期死亡1例。随访的70例存活患者中,纽约心脏病学会(NYHA)心功能分级Ⅰ~Ⅱ级,无发生抗凝意外及再次行三尖瓣置换手术者。结论·左心瓣膜术后继发性三尖瓣反流应密切随访,及时合理的三尖瓣置换术可以取得良好的围术期及中期临床疗效;孤立性三尖瓣置换术首选右前外侧切口。
[Abstract]:Objective to analyze the perioperative and metaphase results of tricuspid valve replacement after left heart valve operation and to explore the pathogenesis and risk factors of secondary tricuspid regurgitation. Methods the clinical data of 85 patients undergoing tricuspid valve replacement after left heart valve operation were analyzed retrospectively. The patients were divided into two groups according to the type of artificial valves, including the biological valve group (n = 50) and the mechanical valve group (n = 35), and the right anterolateral incision group (n = 51) and the median incision group (n = 34). Results there were 7 cases of death in hospital, including early death in hospital (5.9% in 5 cases within 30 days after operation) and late death (2.4% in 2 cases 30 days after operation). The causes of death were severe right heart failure and low cardiac output after operation. There was no significant difference in mortality between the biological flap group and the mechanical valve group (蠂 ~ 2 / 0. 009 / P ~ (1.000); the median incision group: 6 / 34) and the right anterolateral incision group (1 / 51). The difference was statistically significant (蠂 ~ (26.642) P 0.015 ~ (15). 74 cases were followed-up for 31.5 卤23.1months, 4 cases died in the middle stage, all of them were mechanical valve group, including 3 cases of cardiac death and 1 case of late intestinal cancer death. Among the 70 patients who were followed up, NYHA had no anticoagulant accident and tricuspid valve replacement. Conclusion the secondary tricuspid regurgitation after left heart valve operation should be followed up closely, and a timely and reasonable tricuspid valve replacement can obtain good perioperative and intermediate clinical effect, and solitary tricuspid valve replacement is the first choice of right anterolateral incision.
【作者单位】：上海交通大学附属胸科医院心外科;
【基金】：上海市胸科医院科技发展基金项目(YZ14-01)~~
【分类号】：R654.2

【参考文献】