[1]杨　勇,魏东明,陈亚武.闭式体外循环下微创主动脉瓣膜置换术治疗主动脉瓣病变疗效观察[J].新乡医学院学报,2021,38(10):970-976.[doi:10.7683/xxyxyxb.2021.10.015]
　YANG Yong,WEI Dongming,CHEN Yawu.Effect of minimally invasive aortic valve replacement under closed cardiopulmonary bypass in the treatment of aortic valve disease[J].Journal of Xinxiang Medical University,2021,38(10):970-976.[doi:10.7683/xxyxyxb.2021.10.015]
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闭式体外循环下微创主动脉瓣膜置换术治疗主动脉瓣病变疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年10
页码:
970-976
栏目:
临床研究
出版日期:
2021-10-05

文章信息/Info

Title:
Effect of minimally invasive aortic valve replacement under closed cardiopulmonary bypass in the treatment of aortic valve disease
作者:
杨　勇; 魏东明; 陈亚武
（空军军医大学第一附属医院心血管外科，陕西　西安　710032）
Author(s):
YANG Yong; WEI Dongming; CHEN Yawu
(Department of Cardiovascular Surgery,the First Affiliated Hospital of Air Force Military Medical University,Xi′an 710032,Shaanxi Province,China)
关键词:
主动脉瓣病变; 主动脉瓣置换术; 闭式体外循环; 微创手术; 心功能; 心型脂肪酸结合蛋白; 肌钙蛋白T; 超氧化物歧化酶; 肿瘤坏死因子-α
Keywords:
aortic valvular disease; aortic valve replacement; closed cardiopulmonary bypass; minimally invasive surgery; heart function; heart muscle fatty acid-binding protein; cardiac troponin T; superoxide dismutase; tumor necrosis factor-α
分类号:
R654
DOI:
10.7683/xxyxyxb.2021.10.015
文献标志码:
A
摘要:
目的　探讨闭式体外循环下微创主动脉瓣膜置换术（AVR）治疗主动脉瓣病变的临床效果。方法　选择2016年1月至2019年4月空军军医大学第一附属医院收治的118例主动脉瓣病变患者为研究对象，根据手术方法将患者分为观察组和对照组，每组59例。观察组患者给予闭式体外循环下微创AVR，对照组患者给予传统胸骨正中切口AVR。记录并比较2组患者的体外循环时间、主动脉阻断时间、术后12 h引流量、术后辅助呼吸时间、重症监护室（ICU）住院时间及总住院时间；分别于术前及术后第3、7天检测2组患者血清心肌肌钙蛋白T（cTnT）、心型脂肪酸结合蛋白（H-FABP）、氨基末端脑利钠肽前体（NT-proBNP）、肌酸激酶同工酶（CK-MB）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、细胞间黏附分子1（ICAM-1）、超氧化物歧化酶（SOD）、丙二醛（MDA）及晚期氧化蛋白产物（AOPP）水平。分别于术前及术后第7、30天采用GE Vivid 7心脏彩色超声诊断仪检测2组患者左心室舒张末期内径（LVDD）、左心室收缩末期内径（LVDS）和左心室射血分数（LVEF）；观察2组患者术后深部切口感染、低心排血量综合征、脑血管意外等并发症发生情况；2组患者术后随访1 a，观察患者生存状况。结果　观察组患者体外循环时间和主动脉阻断时间显著长于对照组，术后12 h引流量显著少于对照组，术后辅助呼吸时间、ICU住院时间和总住院时间显著短于对照组（P＜0.05）。术前2组患者血清cTnT、NT-proBNP、H-FABP、CK-MB水平比较差异无统计学意义（P＞0.05），2组患者术后第3天血清cTnT、NT-proBNP、H-FABP、CK-MB水平显著高于术前（P＜0.05），2组患者术后第7天血清cTnT、NT-proBNP、H-FABP、CK-MB水平显著低于术后第3天（P＜0.05）；术后第3、7天，观察组患者血清cTnT、NT-proBNP、H-FABP、CK-MB水平显著低于对照组（P＜0.05）。术前2组患者血清TNF-α、IL-1β、ICAM-1、SOD、MDA、AOPP水平比较差异无统计学意义（P＞0.05）；2组患者术后第3天血清TNF-α、IL-1β、ICAM-1、MDA、AOPP水平显著高于术前，血清SOD水平显著低于术前（P＜0.05）；2组患者术后第7天血清TNF-α、IL-1β、ICAM-1、MDA、AOPP水平显著低于术后第3天，血清SOD水平显著高于术后第3天（P＜0.05）；术后第3、7天，观察组患者血清TNF-α、IL-1β、ICAM-1、MDA、AOPP水平显著低于对照组，血清SOD水平显著高于对照组（P＜0.05）。术前2组患者LVDD、LVDS、LVEF比较差异无统计学意义（P＞0.05）；2组患者术后第7、30天LVDD、LVDS显著低于术前，LVEF显著高于术前（P＜0.05）；2组患者术后第30天LVDD、LVDS显著低于术后第7天，LVEF显著高于术后第7天（P＜0.05）；术后第7天，观察组患者LVDD、LVDS显著低于对照组，LVEF显著高于对照组（P＜0.05）；术后第30天，2组患者LVDD、LVDS、LVEF比较差异无统计学意义（P＞0.05）。观察组和对照组患者并发症发生率分别为3.39%（2/59）、13.56%（8/59），观察组患者并发症发生率显著低于对照组（χ2=5.933，P＜0.05）。观察组和对照组患者术后1 a生存率分别为98.18%（54/55）、94.44%（51/54），2组患者术后1 a生存率比较差异无统计学意义（χ2=1.076，P＞0.05）。结论　与传统的胸骨正中切口AVR比较，闭式体外循环下微创AVR治疗主动脉瓣病变可以减少术后引流量少，缩短住院时间，减轻机体应激、炎症反应及心脏损伤，改善患者术后早期左心室功能，促进患者恢复，降低术后并发症发生率。
Abstract:
Objective　To investigate the clinical effect of minimally invasive aortic valve replacement (AVR) under closed cardiopulmonary bypass in the treatment of aortic valve disease.Methods　A total of 118 patients with aortic valve disease treated in the First Affiliated Hospital of Air Force Military Medical University from January 2016 to April 2019 were selected as the research subjects.According to the surgical methods,the patients were divided into observation group and control group,with 59 cases in each group.The patients in the observation group were treated with minimally invasive AVR under closed cardiopulmonary bypass,and the patients in the control group were given traditional median sternal incision AVR.The cardiopulmonary bypass time,aortic occlusion time,drainage volume within 12 hours after operation,postoperative auxiliary breathing time,hospitalization time in intensive care unit (ICU) and the total hospitalization time were recorded and compared between the two groups.The levels of serum cardiac troponin T (cTnT),heart muscle fatty acid-binding protein (H-FABP),N-terminal pro brain natriuretic peptide (NT-proBNP),creatine kinase-MB (CK-MB),tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β),intercellular cell adhesion molecule-1 (ICAM-1),superoxide dismutase (SOD),malondialdehyde (MDA) and advanced oxidation protein products (AOPP) were detected before operation and on the third and seventh days after operation.The left ventricular end diastolic diameter (LVDD),left ventricular end systolic diameter (LVDS) and left ventricular ejection fraction (LVEF) were measured by GE Vivid 7 cardiac color ultrasound diagnostic instrument before operation and on the seventh and thirtieth days after operation.The postoperative complications such as deep incision infection,low cardiac output syndrome and cerebrovascular accident were observed in the two groups.The patients in the two groups were followed up for one year after operation to observe the survival status.Results　Compared with the control group,the cardiopulmonary bypass time and aortic occlusion time in the observation group were significantly longer,and drainage volume within 12 hours after operation was significantly less,and the postoperative auxiliary breathing time,hospitalization time in ICU and the total hospitalization time were significantly shorter (P＜0.05).There was no significant difference in the levels of serum cTnT,NT-proBNP,H-FABP and CK-MB between the two groups before operation (P>0.05).The levels of serum cTnT,NT-proBNP,H-FABP and CK-MB in the two groups on the third day after operation were significantly higher than those before operation (P＜0.05).The levels of serum cTnT,NT-proBNP,H-FABP and CK-MB on the seventh day after operation were significantly lower than those on the third day after operation (P＜0.05).The levels of serum cTnT,NT-proBNP,H-FABP and CK-MB in the observation group were significantly lower than those in the control group on the third and seventh days after operation (P＜0.05).There was no significant difference in the levels of serum TNF-α,IL-1β,ICAM-1,SOD,MDA and AOPP between the two groups before operation (P>0.05).In the two groups,the levels of serum TNF-α,IL-1β,ICAM-1,MDA and AOPP on the third day after operation were significantly higher than those before operation,and the level of serum SOD on the third day after operation was significantly lower than that before operation (P＜0.05).In the two groups,the levels of serum TNF-α,IL-1β,ICAM-1,MDA and AOPP on the seventh day after operation were significantly lower than those on the third day after operation,and the level of serum SOD was significantly higher than that on the third day after operation (P＜0.05).On the third and seventh day after operation,the levels of serum TNF-α,IL-1β,ICAM-1,MDA and AOPP in the observation group were significantly lower than those in the control group,and the level of serum SOD was significantly higher than that in the control group (P＜0.05).There was no significant difference in LVDD,LVDS and LVEF between the two groups before operation (P>0.05).The LVDD and LVDS on the seventh and thirtieth days after operation were significantly lower than those before operation,and the LVEF on the seventh and thirtieth days after operation was significantly higher than that before operation in the two groups (P＜0.05).In the two groups,the LVDD and LVDS on the thirtieth day after operation were significantly lower than those on the seventh day after operation,and the LVEF on the thirtieth day after operation was significantly higher than that on the seventh day after operation (P＜0.05).On the seventh day after operation,the LVDD and LVDS in the observation group were significantly lower than those in the control group,and the LVEF in the observation group was significantly higher than that in the control group (P＜0.05).There was no significant difference in LVDD,LVDS and LVEF between the two groups on the thirtieth day after operation (P>0.05).The incidence of complications in the observation group and the control group was 3.39% (2/59) and 13.56% (8/59),respectively.The incidence of complications in the observation group was significantly lower than that in the control group (χ2=5.933,P＜0.05).The 1-year survival rate in the observation group and the control group was 98.18% (54/55) and 94.44% (51/54),respectively.There was no significant difference in the 1-year survival rate between the two groups (χ2=1.076,P＞0.05).Conclusion　Compared with the traditional median sternal incision AVR,the minimally invasive AVR under closed cardiopulmonary bypass can decrease postoperative drainage,shorten hospitalization time,alleviate body stress reaction,inflammatory reaction and heart injury,improve early postoperative left ventricular function,promote postoperative recovery and reduce the incidence of postoperative complications.

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更新日期/Last Update: 2021-10-05