中重度缺血性二尖瓣反流手术疗效的比较研究

doi:10.3969/j.issn.1006-7795.2015.03.003

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (3): 345-353.doi: 10.3969/j.issn.1006-7795.2015.03.003

• 心脏大血管外科领域前沿进展 • 上一篇下一篇

中重度缺血性二尖瓣反流手术疗效的比较研究

尹博, 王晓龙, 刘愚勇, 郑铁, 贡鸣, 李海洋, 刘欧, 关欣亮, 彭小乐, 姜文剑, 黄琦, 郭冬, 张宏家

首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所教育部心血管重塑相关疾病重点实验室北京市大血管疾病诊疗中心北京市大血管外科植入式人工材料工程技术研究中心, 北京 100029

收稿日期:2015-03-18 出版日期:2015-06-21 发布日期:2015-06-15
通讯作者: 张宏家 E-mail:zhanghongjia722@hotmail.com
基金资助:
国家自然科学基金(81170283,81470580),北京市自然科学基金(7112041),教育部"新世纪优秀人才支持计划"(NCET-11-0899).

Comparative study on effect of surgery for moderate/severe ischemic mitral regurgitation

Yin Bo, Wang Xiaolong, Liu Yuyong, Zheng Tie, Gong Ming, Li Haiyang, Liu Ou, Guan Xinliang, Peng Xiaole, Jiang Wenjian, Huang Qi, Guo Dong, Zhang Hongjia

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing Aortic Disease Medical Center, Beijing Engineering Research Center for Vascular Prostheses, Beijing 100029, China

Received:2015-03-18 Online:2015-06-21 Published:2015-06-15
Supported by:
This study was supported by National Natural Science Foundation of China (81170283, 81470580), Natural Science Foundation of Beijing(7112041), New Century Excellent Talents of Ministry of Education(NCET-11-0899).

摘要/Abstract

摘要：

目的该研究主要比较二尖瓣修复术和二尖瓣置换术两种治疗方法对缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)的效果,确定二尖瓣手术方式的不同是否会对患者手术病死率、生存率、反流纠正效果及预后产生影响,探索哪种患者能够从二尖瓣修复术或二尖瓣置换术中获益.方法回顾分析首都医科大学附属北京安贞医院从2003年至2013年的296例患者,均为IMR,反流情况为中、重度,两组患者在体外循环、冠状动脉旁路移植术(coronary artery bypass grafting, CABG)基础上分别进行二尖瓣修复(mitral valve repair,MVP)和二尖瓣置换(mitral valve replacement, MVR),回顾患者基本资料、手术方式、术前及出院后心脏超声结果、围术期事件,对出院患者进行随访,观察长期生存率及心功能状况、再住院情况,采用统计学软件SPSS20.0对收集的数据信息进行分析.结果 1)两组患者在基线数据及手术情况方面差异无统计学意义;2)置换及修复组手术病死率差异无统计学意义(P=0.607);3)长期生存率:1随访中发现置换组有优于修复组的总体生存曲线(P <0.05);2在射血分数>30%的情况下,置换组较修复组生存率有优势(P <0.05);3在年龄 >65岁的高龄组,置换组的生存率优于修复组(P <0.05);4在射血分数≤30%的情况下,置换组和修复组生存率差异无统计学意义(P >0.05);4)在术后情况中,重症加强护理病房(intensive care unit, ICU)停留时间、总住院天数和住院花费方面,修复组要优于置换组(P <0.05);5)在以心脏超声结果为反流纠正效果的衡量标准的比较中,对于反流的纠正的效果和纠正的完全率上,置换组优于修复组.6)在再住院率上,两组差异无统计学意义;7)术后随访存活患者心功能情况,两组差异无统计学意义.结论 1)对于反流的纠正效果,置换组优于修复组;2)两组手术病死率差异无统计学意义;置换组长期生存率总体要优于修复组;3)应结合患者情况进行个体化治疗以获得更好预后:1射血分数 >30%的情况下,为获取更好的长期生存率,建议行置换;2在年龄 >65岁的高龄组,建议行二尖瓣置换;3射血分数≤30%的情况下,置换组和修复组生存率差异无统计学意义,其中年轻患者考虑未来抗凝相关合并症问题,建议进行修复术.

关键词: 缺血性二尖瓣反流, 冠状动脉旁路移植术, 二尖瓣置换, 二尖瓣修复

Abstract:

Objective This study aimed to compare effects of surgeries for mitral valve repair and replacement in patients with ischemic mitral regurgitation (IMR), and to determine whether mitral valve operation in different ways will have an impact on patient mortality, survival rate and prognosis. Methods This study included a total of 296 patients, all had moderate to severe chronic ischemic mitral regurgitation.The patients were divided into two groups; on the basis of coronary artery bypass grafting, group 1 received mitral valve repair and group 2 received mitral valve replacement. The patients were followed up for the long term survival rate and heart function, readmission. Finally, the data were analyzed through statistical method. Results 1) No statistically significant differences in baseline data were found between the two groups of patients, and operation details; 2)The operation mortality: No significant difference was found between mitral valve repair group and mitral replacement group (P=0.607);3) Long term survival curve: mitral valve replacement was better than mitral valve repair on the whole (P <0.05); survival rate of mitral valve replacement group patients was better than that of mitral valve repair group when left ventricular ejection fraction was over 30% (P <0.05); survival rate of patients received mitral valve replacement was better than that of patients received mitral valve repair when age was over 65 years (P <0.05); no significant difference was found between mitral valve replacement and mitral valve repair groups in survival rate when left ventricular ejection fraction was less than 30% (P >0.05). 4) In the postoperative ICU, residence time, total hospital stay and cost were significantly better in mitral valve repair group. 5)Echocardiography showed that regurgitation corrective effect was significantly better in mitral valve replacement group than that of the mitral valve repair group. 6)In the rehospitalization rate, no statistically significant differences was found between the two groups. 7)Follow up of heart function in patients after operation, no significant difference was found between two groups. Conclusion 1) For the effect of correction of regurgitation, mitral valve replacement was superior to repair. 2) Operation mortality was not significantly different between two groups. The long-term survival rate of the replacement group was superior to the repair group. 3) To get better prognosis, method of surgery should be chosen based on patients' condition: when left ventricular ejection fraction is over 30%, mitral valve replacement is advised; when patient's age is over 65 years, replacement is advised; when left ventricular ejection fraction is over 30%, either method is good; If patient is young, considering the long-term anticoagulation problems, mitral valve repair is better.

Key words: ischemic mitral regurgitation, coronary artery bypass grafting, mitral valve replacement, mitral valve repair

中图分类号:

R542.5

尹博, 王晓龙, 刘愚勇, 郑铁, 贡鸣, 李海洋, 刘欧, 关欣亮, 彭小乐, 姜文剑, 黄琦, 郭冬, 张宏家. 中重度缺血性二尖瓣反流手术疗效的比较研究[J]. 首都医科大学学报, 2015, 36(3): 345-353.

Yin Bo, Wang Xiaolong, Liu Yuyong, Zheng Tie, Gong Ming, Li Haiyang, Liu Ou, Guan Xinliang, Peng Xiaole, Jiang Wenjian, Huang Qi, Guo Dong, Zhang Hongjia. Comparative study on effect of surgery for moderate/severe ischemic mitral regurgitation[J]. Journal of Capital Medical University, 2015, 36(3): 345-353.

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中重度缺血性二尖瓣反流手术疗效的比较研究

Comparative study on effect of surgery for moderate/severe ischemic mitral regurgitation

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