风湿性心脏病二尖瓣成形成功率及临床预后分析

Analysis on Mitral Valve Repair Rate and Clinical Prognosis of Patient with Rheumatic Heart Disease

摘要: 目的：探讨风湿性二尖瓣病变行二尖瓣成形术成功率，并比较成功行二尖瓣成形与成形失败后行二尖瓣置换术两组患者的近期临床预后。方法：选取郑州大学华中阜外医院单一治疗组于2020年1月~2022年6月行风湿性二尖瓣成形手术患者共63例，按术式分为成功组(n = 55)和失败组(n = 8)，并比较两组围术期的临床预后。结果：两组的主动脉阻断时间、术后气管插管时间、术后24小时引流量、术后ICU滞留天数、术后住院天数及死亡率等方面差异无统计学意义(P > 0.05)。超声提示失败组术前二尖瓣瓣口面积更小，成功组术后左室收缩末期内径更小(P < 0.05)，两组在术前及其术后左心室功能、肺动脉压、左室舒张末期内径等方面均无统计学差异(P > 0.05)。结论：在有经验的心脏中心，风湿性二尖瓣病变行二尖瓣成形术的成功率可达87.3%，术前二尖瓣瓣口面积小是成形失败的危险因素，对于风湿性二尖瓣病变患者，术中二尖瓣成形失败转二尖瓣置换治疗可以达到满意的治疗效果，对于合适的风湿性二尖瓣病变患者可优先选二尖瓣成形术。

Abstract: Objective: To investigate the mitral valve repair rate of rheumatic heart disease and the short-term clinical result of mitral valvuloplasty and mitral valvuloplasty in the treatment of rheumatic mitral valve disease. Methods: A total of 63 patients in the single center of Fuwai Central China Cardiovascular Hospital who underwent rheumatic mitral valvuloplasty from January 2020 to June 2022 were enrolled. According to the surgical procedure, all patients were divided into two groups: The successful group (n = 55) and the not successful group (n = 8). The clinical prognosis of the two groups was compared during the perioperative period. Results: There were no significant differences in aortic cross-clamping time, postoperative endotracheal intubation time, 24-hour postoperative drainage, postoperative ICU stay length, postoperative hospitalization days, and postoperative mortality between the two groups (P > 0.05). Ultras oniccardiogram showed the preoperative mitral valve area (MVA) was smaller and the postoperative left ventricular end systolic volume was larger in the failed mitral valvuloplasty (P < 0.05). There were no significant differences in left ventricular ejection fractions, pulmonary artery pressure, and left ventricular end diastolic diameter (P > 0.05). Conclusion: The success rate of rheumatic mitral valve repair can reach 87.3%. Smaller mitral valve area (MVA) is a risk factor for repair failure, mitral valve repair can achieve satisfactory treatment effect, and mitral valve repair should be choice for oppropriate patients with rheumatic heart disease.