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摘要: 目的 探讨主动脉瓣环扩大术(ARE)在主动脉瓣环狭小患者中的临床效果，并评估患者术后生活质量。方法 选取2016年1月—2021年3月于郑州大学第一附属医院实施主动脉瓣置换术(AVR)且合并主动脉瓣环狭小患者104例，以同期施行ARE为观察组(34例)，未施行ARE为对照组(70例)，重点比较两组手术资料、围术期情况和术后1年临床结果；并使用中文版SF-36量表对观察组患者手术前后生活质量进行评估。结果 组内比较：观察组手术前后主动脉跨瓣压差(PPG)、主动脉瓣最大流速、左室射血分数(LVEF)、左室径(LVDD)、室间隔厚度(IVST)和左室后壁厚度(LVPWT)差异有统计学意义(P＜0.05)，对照组以上各指标除LVDD(P=0.922)和LVPWT(P=0.082)外，其余指标手术前后差异有统计学意义(P＜0.05)；组间比较：观察组术后PPG和跨瓣流速降低更显著，左室肥厚指标改善更明显，差异有统计学意义(P＜0.05)，观察组在手术时间、体外循环时间、主动脉阻断时间、术后机械通气时间明显延长(P＜0.05)，但不延长术后ICU停留时间和术后住院时间(P＞0.05)，也不增加围术期死亡率、平均输血量和术后并发症的发生率(P＞0.05)；中文版SF-36量表生活质量评估结果示：观察组术后1年患者生活质量明显提高，8个维度得分均高于术前，除情感职能方面外(P=0.077)，其余各维度间比较差异有统计学意义(P＜0.05)。结论 面对主动脉瓣环狭小患者，ARE是安全有效的，术后临床效果显著，患者生活质量明显改善。Abstract: Objective To investigate the clinical effect of aortic root enlargement(ARE) in patients with aortic annulus stenosis and evaluate the quality of life of the patients after operation.Methods From January 2016 to March 2021, 104 patients with aortic valve replacement complicated with small aortic annulus were selected, and ARE was performed at the same time as the observation group(n=34) and without ARE as the control group(n=70). The operative data, perioperative conditions, and clinical results of one year after the operation were compared between the two groups, and the quality of life of the patients in the observation group before and after the operation was evaluated with the Chinese version SF-36 scale.Results The results of the intra-group comparison showed that there were significant differences in aortic transvalvular pressure difference, aortic valve maximum flow velocity, left ventricular ejection fraction, left ventricular diameter, interventricular septum thickness, and left ventricular posterior wall thickness in the observation group before and after the operation. There were significant differences in other indexes(P < 0.05). The results of the comparison between the two groups showed that the transvalvular pressure difference and transvalvular flow velocity decreased more significantly, and the index of left ventricular hypertrophy improved more significantly in the observation groups(P < 0.05). In the observation group, the operation time, cardiopulmonary bypass time, aortic clamping time, and postoperative mechanical ventilation time were significantly prolonged(P < 0.05), but the postoperative ICU stay time and postoperative hospital stay were not prolonged(P > 0.05). It did not increase perioperative mortality, the average blood transfusion volume, and the incidence of postoperative complications(P > 0.05). The results of the quality of life evaluation of the SF-36 scale in the Chinese version showed that the quality of life of the patients in the observation group was significantly improved 1 year after the operation, and the scores of 8 dimensions were higher than those before operation. Except for emotional function(P=0.077), there were significant differences among the other dimensions(P < 0.05).Conclusion ARE is safe and effective for patients with the small aortic annulus, the postoperative clinical effect is significant, and the quality of life of the patients is significantly improved.
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表 1 两组患者基线资料和术前超声结果
Table 1. General data
例(%), X±S 项目 观察组(34例) 对照组(70例) t/χ2值 P值 年龄/岁 61.06±10.20 58.24±10.23 1.318 0.191 女性 21(61.8) 46(65.7) 0.156 0.693 BMI/(kg·m-2) 22.75±2.53 22.49±3.59 0.376 0.708 体表面积/m2 1.66±0.14 1.67±0.11 -0.490 0.625 病变类型 风湿性 12(35.3) 23(32.9) 0.061 0.805 退行性 20(58.8) 42(60.0) 0.013 0.909 先天畸形 2(5.9) 5(7.1) 0.000 1.000 合并疾病 冠心病 9(26.5) 13(18.6) 0.856 0.355 心房颤动 7(20.6) 15(21.4) 0.010 0.922 高血压 16(47.1) 26(37.1) 0.935 0.334 卒中史 4(11.8) 6(8.6) 0.027 0.870 NYHA分级≥Ⅲ级 24(70.6) 47(67.1) 0.125 0.723 术前超声 AVAD/mm 19.06±1.76 19.44±1.04 -1.177 0.245 PPG/mmHg△ 76.61±15.45 75.75±14.74 0.247 0.785 V Max/(m·s-1) 3.44±1.22 3.73±1.04 -1.270 0.207 LVDD/mm 53.89±5.30 53.34±4.31 0.555 0.580 IVST/mm 11.61±2.13 11.82±1.86 -0.504 0.615 LVPWT/mm 11.21±2.34 11.22±1.86 -0.009 0.992 LVEF/% 54.62±6.22 56.04±4.89 -1.272 0.206 AVAD：主动脉瓣环径；PPG：主动脉跨瓣压差；V Max：主动脉瓣最大流速；LVDD：左室径；IVST：室间隔厚度；LVPWT：左室后壁厚度；LVEF：左室射血分数。△1 mmHg=0.133 kPa。 
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表 2 两组患者围术期资料比较
Table 2. Perioperative data of the two groups
例(%), X±S 项目 观察组(34例) 对照组(70例) t/χ2值 P值 手术时间/min 267.41±42.57 210.96±39.84 6.628 ＜0.001 体外循环时间/min 173.09±41.40 143.39±38.19 3.619 ＜0.001 主动脉阻断时间/min 129.44±36.31 113.17±37.62 2.092 0.039 术后ICU停留时间/d 2.47±0.83 2.36±0.70 0.729 0.468 机械通气时间/h 11.78±3.27 10.36±3.14 2.130 0.036 24 h引流量/mL 394.85±67.37 390.07±68.92 0.334 0.739 围术期死亡 1(2.9) 1(1.4) — 0.549 同期合并手术 CABG 3(8.8) 6(8.6) 0.000 1.000 心房颤动消融 4(11.8) 6(8.6) 0.027 0.870 瓣膜种类 0.645 0.422 机械瓣 9(26.5) 24(34.3) 生物瓣 25(73.5) 46(65.7) 输血量 血浆/mL 414.71±200.20 375.71±165.45 1.051 0.296 红细胞/U 2.21±1.39 1.89±1.27 0.848 0.398 术后并发症 开胸探查 1(2.9) 2(2.9) — 1.000 肺部感染 4(11.8) 5(7.1) 0.172 0.678 术后住院时间/d 7.44±1.97 6.80±1.73 1.691 0.094 注：CABG：冠状动脉旁路移植术；“—”：Fisher精确概率法。
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表 3 两组患者手术前后心脏超声结果
Table 3. Echocardiographic results of the two groups before and after surgery
X±S 项目 观察组(34例) 对照组(70例) 术前 术后 t值 P值 术前 术后 t值 P值 PPG/mmHg 76.61±15.45 19.82±3.75 20.628 ＜0.001 75.75±14.74 35.15±7.12 34.269 ＜0.001 V Max/(m·s-1) 3.44±1.22 1.64±0.40 8.253 ＜0.001 3.73±1.04 2.26±0.46 11.634 ＜0.001 LVDD/mm 53.89±5.30 43.18±3.25 10.807 ＜0.001 53.34±4.31 53.31±3.95 0.098 0.922 IVST/mm 11.61±2.13 10.09±1.96 3.675 0.001 11.82±1.86 11.00±1.30 4.456 ＜0.001 LVPWT/mm 11.21±2.34 9.95±1.79 3.119 0.004 11.22±1.86 10.89±1.38 1.767 0.082 LVEF/% 54.62±6.22 62.38±4.21 -5.614 ＜0.001 56.04±4.89 60.41±2.66 -6.651 ＜0.001
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表 4 两组术后心脏超声结果比较
Table 4. Postoperative cardiac ultrasound results between the two groups after surgery
X±S 项目 观察组 对照组 t值 P值 PPG/mmHg 19.82±3.75 35.15±7.12 -14.372 ＜0.001 V Max/(m·s-1) 1.64±0.40 2.26±0.46 -6.759 ＜0.001 LVDD/mm 43.18±3.25 53.31±3.95 -12.979 ＜0.001 IVST/mm 10.09±1.96 11.00±1.30 -2.817 0.006 LVPWT/mm 9.95±1.79 10.89±1.38 -2.968 0.004 LVEF/% 62.38±4.21 60.41±2.66 2.497 0.016
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表 5 观察组患者生活质量评估
Table 5. Evaluation of quality of life of patients in observation group
分, X±S 项目 术前 术后 t值 P值 生理机能 52.65±10.24 58.24±8.43 -2.380 0.023 生理职能 50.74±17.93 84.56±13.78 -8.928 ＜0.001 躯体疼痛 71.68±11.07 76.06±7.95 -2.159 0.038 一般健康状况 45.32±6.28 62.62±12.07 -7.532 ＜0.001 精力 56.47±7.34 69.85±15.39 -4.316 ＜0.001 社会功能 49.63±11.71 68.01±10.74 -6.934 ＜0.001 情感职能 71.57±21.92 81.37±27.45 -1.827 0.077 精神健康 60.71±11.42 74.12±16.19 -3.923 ＜0.001
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| 引用本文: |
孔强强, 马宁, 罗鸿, 等. 主动脉瓣环扩大术后临床效果和生活质量评估[J]. 临床心血管病杂志, 2022, 38(9): 725-730. doi: 10.13201/j.issn.1001-1439.2022.09.009
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| Citation: |
KONG Qiangqiang, MA Ning, LUO Hong, et al. Evaluation of clinical effect and quality of life after aortic root enlargement[J]. J Clin Cardiol, 2022, 38(9): 725-730. doi: 10.13201/j.issn.1001-1439.2022.09.009
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