摘要
目的 比较姑息性二尖瓣手术与单纯药物治疗继发性非缺血性二尖瓣反流的效果。方法 回顾性分析上海交通大学医学院附属瑞金医院2009—2019年收治的继发性非缺血性二尖瓣反流患者的临床资料。其中左心室射血分数<40%的患者行多巴酚丁胺负荷试验,以左心室射血分数较基础值改善>15%判定为结果阳性。将阳性患者分为手术组和药物组,手术组行外科二尖瓣修复或置换,药物组采用单纯药物治疗。术后每半年门诊或电话随访患者生存及心功能情况,术后1年行心脏超声检查。主要研究终点为全因死亡、心力衰竭再住院、心脏移植的复合终点,并比较两组在心功能及心脏超声参数上的差异。结果 最终纳入患者41例,其中男28例、女13例,平均年龄(55.5±11.1)岁。手术组25例、药物组16例。中位随访时间16(1~96)个月,两组复合终点发生率差异无统计学意义[HR=0.499,95%CI(0.523,1.631),P=0.229],手术组全因死亡率低于药物组[HR=0.124,95%CI(0.024,0.641),P=0.034],手术组的心功能分级及二尖瓣反流水平均优于药物组(手术组心功能分级Ⅰ~Ⅱ级占68.0%,药物组占18.8%,P<0.01;药物组87.5%的患者随访时存在中度或以上二尖瓣反流,手术组均为中度以下反流,P<0.01);两组心脏超声参数术前和随访差值差异无统计学意义(P>0.05)。结论 对于有一定心脏收缩功能储备的继发性非缺血性二尖瓣反流,行姑息性外科二尖瓣手术较单纯药物治疗能够改善生存、提高生活质量。
Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation.Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed.Patients with a left ventricular ejection fraction(LVEF)<40% underwent a dobutamine stress test,and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value.Positive patients were divided into a surgery group and a medication group.The surgery group underwent surgical mitral valve repair or replacement,while the medication group received simple medication treatment.Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery,and patients underwent cardiac ultrasound examination one year after surgery.The main research endpoint was a composite endpoint of all-cause death,heart failure readmission,and heart transplantation,and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared.Results Ultimately 41 patients were collected,including 28 males and 13 females with an average age of 55.5±11.1 years.Twenty-five patients were in the surgery group and sixteen patients in the medication group.The median follow-up time was 16 months,ranging 1-96 months.The occurrence of all-cause death in the surgery group was lower than that in the medication group(HR=0.124,95%CI 0.024-0.641,P=0.034).The difference between the two groups was not statistically significant in the composite endpoint(HR=0.499,95%CI 0.523-1.631,P=0.229).The New York Heart Association(NYHA) grade of the surgery group was better(NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group,P<0.01) as well as the grade of mitral valve regurgitation(87.5% of the patients in the medication group had moderate or above regurgitation at follow-up,while all the patients in the surgery
作者
徐旖炜
周密
朱嘉希
康磊
叶晓峰
裘佳培
李海清
王哲
陈安清
赵强
XU Yiwei;ZHOU Mi;ZHU Jiaxi;KANG Lei;YE Xiaofeng;QIU Jiapei;LI Haiqing;WANG Zhe;CHEN Anqing;ZHAO Qiang(Department of Cardiovascular Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200032,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第7期1000-1006,共7页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
