保留后瓣及瓣下结构对风湿性二尖瓣狭窄患者心肌应变力的影响

李绪东; 夏旭; 刘秋华

doi:10.12125/j.chj.202209019

保留后瓣及瓣下结构对风湿性二尖瓣狭窄患者心肌应变力的影响

Effect of preserving posterior and subvalvular structures on myocardial strain in patients with rheumatic mitral stenosis

摘要

摘要:
目的探究保留后瓣及瓣下结构对风湿性二尖瓣狭窄（RMS）患者心肌应变力的影响。
方法选择2014年1月～2022年5月清远市人民医院收治的RMS患者（106例）为研究对象，根据术中是否保留后瓣及瓣下结构，分为保留组（56例）和未保留组（50例）。对比分析两组患者的临床资料、超声参数、心肌应变力以及术后并发症。
结果与未保留组相比，保留组患者的ICU滞留时间、呼吸机辅助时间以及住院时间均更短（均P<0.01）。术后1个月，与未保留组相比，保留组患者的左心室舒张末期内径（LVEDD）以及左心室舒张末期容积（LVEDV）均更低（均P<0.01），左心室短轴缩短率（LVFS）（P<0.05）以及左心室射血分数（LVEF）（P<0.01）均更高。与未保留组相比，术后3个月保留组患者左心室心肌收缩期峰值应变（Ss）（基底段P<0.05，中间段P<0.01）以及收缩期峰值应变率（SRs）（基底段P<0.01，中间段P<0.05）均更高。与术前相比，未保留组患者术后1个月左心室心肌Ss均更低（均P<0.01），保留组患者术后1个月左心室心肌基底段与中间段Ss及SRs均更低（均P<0.01），术后3个月左心室心肌基底段与中间段Ss（均P<0.05）以及左心室心肌基底段与中间段SRs（均P<0.01）均更高。与术后1个月相比，未保留组患者术后3个月左心室心肌Ss以及左心室心肌SRs均更高（均P<0.05），保留组患者术后3个月左心室心肌Ss以及左心室心肌SRs均更高（均P<0.01）。与未保留组相比，保留组患者术后1个月并发症发生概率更低（P<0.05）。
结论保留后瓣及瓣下结构的RMS患者ICU滞留时间、呼吸机辅助时间以及住院时间均显著缩短，有助于术后恢复心功能以及减少并发症，临床效果显著。

Abstract:
AIM To investigate the effect of preserving the posterior and subvalvular structures on myocardial strain in patients with rheumatic mitral stenosis (RMS).
METHODS RMS patients (106 cases) admitted to Qingyuan People's Hospital from January 2014 to May 2022 were selected as the research subjects, and according to whether the posterior valve and subvalvular structures were preserved during the operation, they were divided into preservation group (56 cases) and non preservation group (50 cases). The clinical data, ultrasound parameters, myocardial strain and postoperative complications of the two groups were compared and analyzed.
RESULTS Compared with the non preservation group, the preservation group had shorter ICU retention time, ventilator assistance time and hospital stay (all P<0.01). One month after operation, compared with the non preservation group, the left ventricular end diastolic diameter (LVEDD) and left ventricular end diastolic volume (LVEDV) of the preservation group were lower (all P<0.01), and the left ventricular short axis shortening rate (LVFS) (P<0.05) and left ventricular ejection fraction (LVEF) (P<0.01) were higher. Compared with the non preservation group, the left ventricular peak systolic strain (Ss) (basal segment P<0.05, middle segment P<0.01) and systolic peak strain rate (SRs) (basal segment P<0.01, middle segment P<0.05) of the preservation group were higher 3 months after operation. Compared with that before operation, the left ventricular myocardial Ss of the patients in the non preservation group were lower 1 month after operation (all P<0.01), the left ventricular myocardial Ss and SRs of the basal and middle segments were lower 1 month after operation in the preservation group (all P<0.01), and the left ventricular myocardial Ss of the basal and middle segments were higher 3 months after operation (all P<0.05), and the left ventricular myocardial SRs of the basal and middle segments were higher (all P<0.01). Compared with 1 month after operation, the left ventricular myocardial Ss and SRs of patients in the non preservation group were higher 3 months after operation (all P<0.05), and those in the preservation group were higher 3 months after operation (all P<0.01). Compared with the non preservation group, the preservation group had a lower probability of complications 1 month after surgery (P<0.05).
CONCLUSION The retention time in ICU, ventilator assistance time and hospitalization time of RMS patients with preserved posterior valve and subvalvular structures were significantly shortened, which was helpful for postoperative recovery of cardiac function and reduction of complications, and the clinical effect was significant.

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