Edwards MC3成形环和De Vega成形术治疗继发性三尖瓣关闭不全的近期效果对比

发布时间：2018-09-14 10:57

【摘要】：目的:心脏瓣膜病行二尖瓣置换和(或)主动脉瓣置换同期对继发三尖瓣反流采取瓣膜成形术,对比采用Edwards MC3成形环和De Vega成形术治疗三尖瓣反流的效果,并分析术后三尖瓣再次反流的影响因素。方法:选取至2015年1月至2016年3月在四川绵阳四0四医院心脏大血管外科因心脏瓣膜病行二尖瓣置换和(或)主动脉瓣置换同期行三尖瓣成形术的患者共60例进行分析,根据随机分组的原则,采用“信封法”分为两组,其中一组为MC3成形环组,共计30例,另一组为De Vega缝线组,共计30例。收集所有患者入院时术前一般资料、NYHA心功能分级、超声心动图等相关观察指标,手术相关指标,以及术后1周,术后3个月,术后6个月,术后1年心脏功能、超声心动图等相关指标,观察患者术前、术后左室心脏功能、肺动脉收缩压力、左心房室直径、右心房室直径、三尖瓣瓣环径、三尖瓣反流程度变化情况,对比二尖瓣置换和(或)主动脉瓣置换同期行三尖瓣成形的效果。结果:两组患者术前一般资料对比(P0.05,差异无统计学意义)。术前两组患者的经胸超声心动图在房室大小对比中(P0.05差异无统计学意义)。MC3成形环组与De Vega缝线组术前LVEF(%)分别为51.51±6.38与50.13±6.06,TV瓣环径(mm)分别为45.57±8.85与45.40±8.27,三尖瓣反流程度分别为2.26±1.07,肺动脉收缩压s PAP(mm Hg)分别为49.37±13.09与47.23±13.37,上述四组对比结果无差异(P0.05,差异无统计学意义)。两组患者除三尖瓣成形手术外,余手术方式比较无差异(P0.05,差异无统计学意义)。两组患者在手术时间、体外循环时间、升主动脉阻断时间、术后呼吸机辅助时间、术后ICU停留时间、总住院时间对比结果无差异(P0.05,差异无统计学意义)。手术前后比较两组患者NYHA心功能分级,两组患者组内比较,术后3个月、6个月、12个月都较术前好转(P0.05,差异无统计学意义),术后1周心功能较术前比较稍差(P0.05,差异有统计学意义),主要是由于手术后心功能还未完全恢复所导致,术后同一时期对比两组患者心功能分级无差异(P0.05,差异无统计学意义)。术后与随访期间MC3成形环组与De Vega缝线组的患者三尖瓣反流情况较术前均明显好转,三尖瓣反流等级明显改善(均为P0.05),术后1周、3个月、6个月、1年期间两组患者间的三尖瓣反流等级无显著的差异(P0.05)。MC3成形环组与De Vega缝合组术后1周、3个月、6个月、12个月的三尖瓣瓣环径大小与术前比较,均明显减小(P0.05),且无再次扩张病例。结论:治疗左心瓣膜疾病伴功能性三尖瓣关闭不全主要同期采用三尖瓣成形术治疗。De Vega缝合法治疗继发性三尖瓣关闭不全在近期可有效减少反流量,有效改善患者的NYHA心功能分级。Edwards MC3人工成形治疗继发性三尖瓣关闭不全在近期可有效改善三尖瓣反流,显著提高患者心功能。使用Edwards MC3成形环与De Vega成形术两种方式后的近期三尖瓣瓣环径较术前均明显缩小,恢复至正常大小,且固定稳固,均无明显的再次扩大。De Vega缝合法与Edwards MC3人工成形治疗继发性三尖瓣关闭不全的近期效果肯定,且两者间无明显差异,远期效果有待进一步研究。为临床工作中治疗继发性三尖瓣关闭不全提供临床依据。
[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.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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