两种人工二尖瓣瓣膜置换前后左右心室收缩功能的比较

摘要

Objective To observe the changing of myocardiac contraction function in patients undergoing mitral valve replacement after cardiac pulmonary bypass and evaluate the influence of the two valve on hemodynamics. Methods From April to June 2013, in the First Hospital of Nanjing City, 25 patients (ASAIIorⅢ, NYHAIIorⅢ, LVEF≥45%, aged 18-78 years old) scheduled for mitral valve replacement (MVR) or double valve replacement (DVR) requiring CPB were divided into two groups, mechanical prosthesis valve group (group M, 15 cases) and bioprosthesis valve group (group B, 9 cases). Anesthesia was maintained with intravenous-inhalation anesthesia, HR、MAP、CVP、PAOP、CI、LVEF and RVEF were measured before sternotomy (T1), at 30 min after CPB (T2) and after closure of the incision (T3). Results There was no statistical significance difference of all targets between the two groups (P> 0.05). In group M, the level of CI at T2 [(2.5±0.4) L/(min·m2)] and T3[(2.5±0.5) L/(min·m2)] were higher than CI at T1 [(1.6±0.4) L/(min·m2)], the differences were statistically significant (P<0.01). In group B, the level of CI at T2 [(2.6±0.4) L/(min·m2)] and T3 [(2.5±0.5) L/(min·m2)] were higher than CI at T1[(1.8±0.5) L/(min·m2)], the differences were statistically significant (P< 0.01). The level of CI increases after CPB both in the two groups. However, there was no statistical significance dif-ference between group M and group B (P>0.05). Conclusion There is no changing of myocardiac contraction function in patients undergoing mitral valve replacement after cardiac pulmonary bypass.%目的：观察二尖瓣置换术(MVR)患者心肺转流术(CPB)前后左右心室收缩功能的变化，评价不同人工瓣膜对血流动力学的影响。方法选择2013年4~6月南京医科大学附属南京医院胸心血管外科择期在CPB下行MVR或者同期行主动脉瓣置换术(DVR)的患者25例，年龄25~78岁，ASA分级Ⅱ或Ⅲ级，术前NYHA心功能分级Ⅱ或Ⅲ级，左室射血分数(LVEF)≥45%。术中麻醉维持均采用静吸复合麻醉。按置换人工二尖瓣瓣膜的类型将患者分为机械瓣膜组(M组，16例)和生物瓣膜组(B组，9例)。分别于麻醉诱导后(T1)，CPB停机后30 min(T2),关胸后(T3)记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、肺动脉堵塞压(PAOP)、心脏指数(CI)、左室射血分数(LVEF)、右室射血分数(RVEF)。结果各监测指标(MAP、CVP、PAOP、LVEF、RVEF、CI)M组与B组相同时间点比较差异无统计学意义(P>0.05)。 M组患者CPB后，T2、T3时CI值[(2.5±0.4)L/(min·m2)、(2.5±0.5)L/(min·m2)]较T1[(1.6±0.4)L/(min·m2)]明显增高，差异有高度统计学意义(P<0.01)；B组患者CPB后，T2、T3时CI值[(2.6±0.4)L/(min·m2)、(2.5±0.5)L/(min·m2)]较T1[(1.8±0.5)L/(min·m2)]明显增高，差异有高度统计学意义(P<0.01)。 M组与B组间比较差异无统计学意义(P>0.05)。结论 CPB下行MVR的患者停机后左右心室收缩功能无变化。停机后心脏指数值增高，但与置换人工瓣膜的类型无关。