风湿性二尖瓣重度狭窄伴小左室患者围术期综合治疗效果分析

发布时间：2018-11-16 17:11

【摘要】：目的：探讨风湿性二尖瓣重度狭窄伴小左室患者围术期综合治疗后的临床效果。方法：(1)、将风湿性二尖瓣重度狭窄患者共计76例,按照左室大小分为小左室组(研究对象33例)以及非小左室组(研究对象43例)。(2)、收集所有患者入院时、围术期以及术后1年随访时的临床资料,包括：围术期中心静脉压、血管活性药物使用剂量、凝血制剂使用剂量,入院时及术后右心室射血分数、左心室舒张末期容积指数、肺动脉收缩压、肝功、六分钟步行实验距离、心功能分级和SF-36量表评分,术后早期并发症发生率、机械通气时间、监护室入住时间和术后住院时间,术后口服华法林剂量、再住院率、血栓栓塞率、死亡率等各项临床指标。(3)、将各组患者术前与术后资料进行对比,明确各组围术期综合治疗效果；并分析两组患者术前以及术后改善情况的差异。结果：(1)、入院时小左室组中心静脉压明显高于非小左室组,右心室射血分数明显低于非小左室组,差异具有统计学意义(P0.05),且小左室组肝功损伤程度较非小左室组严重；(2)、小左室组治疗后肝功较入院时有所改善,但术后予以“冷沉淀”治疗的患者数量仍明显多于非小左室组；(3)、两组患者术后中心静脉压较入院时均发生显著降低,右心室射血分数均明显上升(P0.05),两组间无明显差异；手术对患者的肺动脉高压改善均非常明显,同时,术后雾化吸入“万他维”(吸入用伊洛前列素溶液)5天组,较未吸入组肺动脉收缩压可有明显降低(P0.05)。术后早期,小左室组维持合适抗凝强度所需华法林剂量明显少于非小左室组(P0.05)。(4)、小左室组术后机械通气时间、监护室入住时间较非小左室组明显延长,肺部并发症发生率增加。(5)、术后随访发现,肺动脉高压患者的肺动脉收缩压均较入院显著改善(P0.05)；两组患者肝功、再住院率、血栓栓塞率、死亡率、六分钟步行实验距离和心功能分级均无明显差异；小左室组左心室舒张末期容积指数相比入院时有显著升高(P0.05),而且,与非小左室组间已无明显差异；小左室组维持合适的凝血酶原时间(PT)所需服用的华法林剂量与非小左室组之间无明显差异。小左室组患者与非小左室组患者术后生活质量均可得到显著提升,两组患者之间无显著差异。结论：风湿性二尖瓣重度狭窄伴小左室的患者术前状况较非小左室患者差,手术风险大。围术期处理难度高,但经过围术期的合适处理,术后恢复良好,各项指标的恢复程度与非小左室组患者无显著差异。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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