摘要
目的比较常规二尖瓣置换术（ＭＶＲ）与保留瓣下结构的二尖瓣置换术（ＭＶＲＰ）对术后早期血流动力学的影响。方法根据术中是否保留瓣下结构分为３组。Ⅰ组：常规ＭＶＲ，切除全部二尖瓣瓣叶及其瓣下结构；Ⅱ组：保留后瓣及其瓣下组织；Ⅲ组：全部保留二尖瓣装置。术后４小时、２４小时和４８小时分别采用Ｓｗａｎ－Ｇａｎｚ导管测定血流动力学指标：平均肺动脉压（ＭＰＡＰ）、肺毛细血管嵌压（ＰＣＷＰ）、肺血管阻力（ＰＶＲ）、外周血管阻力（ＳＶＲ）、心脏指数（ＣＩ）和左心室每搏作功指数（ＬＶＳＷＩ）。结果术后Ⅰ组ＭＰＡＰ，ＰＶＲ和ＰＣＷＰ均明显高于Ⅱ组和Ⅲ组；而ＣＩ和ＬＶＳＷＩ则低于Ⅱ组和Ⅲ组。结论保留瓣下结构可改善ＭＶＲ术后早期血流动力学。
Objective To compare the routine mitral valve replacement(MVR) with MVR with preservation of the mitral complex on early postoperative hemodynamics. Methods All 28 patients were divided into 3 groups according to preservation of the subvalvular structures or not during operation.Group I:Completely resection of the mitral leaflets, chordae and tendineae, and papillary muscles; group Ⅱ:Preservation of the posterior leaflets and subvalvular structures;group Ⅲ :Completely preservation of the mitral complex.4h, 24h and 48h after operation, Swan Ganz catheter was used to measure hemodynamic index: Mean pulmonary arterial pressure(MPAP),pulmonary vascular resistance(PVR),pulmonary capillary wedge pressure(PCWP),systemic vascular resistance(SVR),cardiac index(CI) and left ventricular stroke work index(LVSWI). Results MPAP,PVR and PCWP in group Ⅰ were far more higher than those in group Ⅱ or group Ⅲ; but CI and LVSWI were markedly lower in group Ⅰ than those in group Ⅱ or group Ⅲ. Conclusion MVR with preservation of the subvalvular structures would improve the early postoperative hemodynamics, which benefit for recovery of the heart function.
出处
《中国胸心血管外科临床杂志》
CAS
1999年第2期77-79,共3页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
二尖瓣置换
保留瓣下结构
血流动力学
Mitral valve replacement
Preservation of the mitral complex
Hemodynamics
