2024 年第 2 期 第 19 卷

二尖瓣成形术治疗二尖瓣关闭不全的效果评价

Evaluation of the effect of mitral valvuloplasty for the treatment of mitral incompetence

作者：成祥军陈丽芳李民邓毅权郑周忠

英文作者：Cheng Xiangjun Chen Lifang Li Min Deng Yiquan Zheng Zhouzhong

单位：广东省江门市中心医院心血管外科，江门529000

英文单位：Department of Cardiovascular Surgery Jiangmen Central Hospital Guangdong Province Jiangmen 529000 China

关键词：二尖瓣关闭不全；二尖瓣反流；二尖瓣置换术；二尖瓣成形术；效果评价

英文关键词：Mitralincompetence;Mitralregurgitation;Mitralvalvereplacement;Mitralvalvuloplasty;Outcomeevaluation

• 摘要：

• 目的  评价二尖瓣成形术（MVP）治疗二尖瓣关闭不全（MI）的效果。方法  选取2019年2月至2021年2月因二尖瓣中重度反流在广东省江门市中心医院施行瓣膜手术的患者90例，将其中行二尖瓣置换术（MVR）患者44例设为对照组，将行MVP的患者46例设为观察组。对比2组手术施行情况指标、术后心脏超声参数指标［左心房内径（LAD）、左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）］、术后病情转归指标以及随访期间手术疗效，记录2组术后2年内不良心脏事件发生情况。结果  观察组手术时间、体外循环时间、关胸时间、呼吸机使用时间、重症监护病房住院时间、拔管时间短于对照组，术中出血量、术后引流量少于对照组，术后LAD、LVEDD小于对照组，LVEF高于对照组，差异均有统计学意义（均P＜0.05）。观察组术后1、2年二尖瓣反流量＞3 ml的患者比例低于对照组［4.3%（2/46）比20.5%（9/44）、6.5%（3/46）比22.7%（10/44）］，差异均有统计学意义（均P＜0.05）。观察组术后2年内不良心脏事件发生率低于对照组（P＜0.05）。结论  MVP治疗MI效果优良，能降低手术创伤与风险，改善心功能，促进病情尽早恢复，且并发症少。

• Objective  To evaluate the effect of mitral valvuloplasty(MVP) for the treatment of mitral incompetence (MI). Methods  Totally 90 patients who underwent valve surgery for moderate to severe mitral regurgitation in Jiangmen Central Hospital, Guangdong Province from February 2019 to February 2021 were included in the study. Among them, 44 patients underwent mitral valve replacement(MVR) surgery as the control group, and 46 patients underwent MVP as the observation group. Surgical performance indicators, postoperative cardiac ultrasound parameters［left atrial diameter(LAD), left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF)］, postoperative disease outcome indicators, and surgical efficacy during follow-up were compared between the two groups. Adverse cardiac events within 2 years after surgery were recorded in both groups. Results  The surgical time, extracorporeal circulation time, chest closure time, ventilator usage time, intensive care unit hospitalization time, and extubation time in the observation group were shorter than those in the control group; the intraoperative bleeding volume and postoperative drainage volume in the observation group were lower than those in the control group, while postoperative LAD and LVEDD in the observation group were smaller than those in the control group; LVEF in the observation group was higher than that in the control group(all P<0.05). The proportion of patients with mitral regurgitation greater than 3 ml in the observation group at 1 and 2 years after surgery was lower than that in the control group ［4.3%(2/46) vs 20.5%(9/44), 6.5%(3/46) vs 22.7%(10/44)］(both P<0.05). The incidence of adverse cardiac events within 2 years after surgery in the observation group was lower than that in the control group(P<0.05). Conclusion  MVP has an excellent therapeutic effect on MI, which can reduce surgical trauma and risk, improve cardiac function, promote early recovery, and have fewer complications.