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二尖瓣生物瓣置换术后并发格林-巴利综合征一例

Impact of Choice of Prosthetic Heart Valves on Quality of Life for Elderly Patients after Mitral Valve Replacement：A Controlled Trial

Objective To evaluate postoperative quality of life （QOL） of patients aged over 65 after mitral valvereplacement （MVR）. Methods Ninety patients aged over 65 undergoing MVR by the same surgical group in Departmentof Cardiovascular Surgery of Anzhen Hospital were prospectively enrolled in this study. There were 62 male and 28 femalepatients with their age of 65-76 （68.6±6.8） years. There were 55 patients with hypertension，38 patients with type 2 diabetes，and all the patients had persistent atrial fibrillation. Nottingham Healthy Profile （NHP，Part I） and Duke Activity StatuIndex （DASI） were used to evaluate preoperative and postoperative QOL. According to the choice of prosthetic heart valves they received，all the patients were divided into two groups with 45 patients in each group: biological valve group and mechanical valve group. All the patients received MVR via the interatrial groove approach under general anesthesia and cardiopulmonary bypass. Mechanical valve replacement was performed using continuous suture without preserving the posterior leaflet of the mitral valve. Biological valve replacement was performed using interrupted suture and some of the posteriorleaflet of the mitral valve was routinely preserved. Patients in both groups underwent intraoperative bilateral pulmonary vein isolation and left atrial appendage ablation using a bipolar radiofrequency ablation device. The left atrial appendage was not excised or ligated. Results Postoperative QOL of all the patients was significantly better than preoperative QOL. There was no statistical difference in NHP and DASI at the 6th month after discharge between the 2 groups. But from the 1st year after discharge，QOL of the biological valve group was significantly better than that of the mechanical valve group. At the 3rd year after discharge，NHP and DASI of the mechanical valve group was not statistically different from those at the 1st year after discharge，but NHP and DASI of the biological valve group was significantly better than those at the 1st year after discharge. Conclusions QOL of elderly patients are significantly improved after MVR. Patients who receive biologicalvalve replacement may acquire better long-term QOL than patients who receive mechanical valve replacement.

心脏生物瓣膜置换术126例临床分析

目的　总结心脏生物瓣膜置换术的临床经验和手术效果。　方法　回顾性分析2008年6月至2010年11月福建省立医院126例患者行心脏生物瓣膜置换手术的临床资料，其中男66例，女60例；年龄27～85 （67.6±10.8）岁。心功能分级（NYHA）Ⅱ～Ⅳ级。风湿性二尖瓣狭窄伴关闭不全101例，心瓣膜退行性变二尖瓣关闭不全20例，二尖瓣腱索断裂导致二尖瓣关闭不全5例；行二尖瓣置换术（MVR）75例，三尖瓣置换术2例，主动脉瓣置换术（AVR）30例，AVR＋MVR（双瓣膜置换术，DVR） 19例。　结果　行MVR升主动脉阻断时间（40.5±7.8） min，体外循环时间（85.3±10.1） min；行AVR升主动脉阻断时间（70.6±12.4） min ，体外循环时间（142.3±15.6） min；行DVR 升主动脉阻断时间（103.5±18.4） min ，体外循环时间（182.3±21.8） min。全组无手术死亡。住院时间（25.7±5.9） d，住重症监护室（ICU）时间（2.5±1.9） d。术后出院前复查心脏彩色超声心动图，未见瓣膜关闭不全。　结论　生物瓣膜具有较高的手术安全性，采用生物瓣的手术风险与机械瓣无异，具有较好的疗效。