刘萍;
LIU Ping;Department of Internal Medicine,Traditional Chinese Medicine Hospital of Fangshan District;

• 1:北京市房山区中医医院内科

摘要(Abstract)：

目的:探讨单纯主动脉瓣关闭不全的主动脉夹层患者的临床治疗方法及效果。方法:确诊并接受治疗的18例表现为单纯主动脉瓣关闭不全的主动脉夹层患者,根据主动脉内膜撕裂程度,窦部破坏情况及既往病史等情况选择不同术式,5例行单纯主动脉瓣成形术,4例行Wheat术,9例行Bentall术;观察3种手术的治疗效果,记录3组患者手术前后左心室舒张末期内径(LVDd)、左心室射血分数(LVEF),患者出院后随访半年,记录术后死亡率及并发症发生情况。结果:3组患者术后仅1例死于慢性肾功能不全,死亡率为5.56%;11例治愈,治愈率为61.1%;术前3组患者LVEF比较,差异无统计学意义(P=0.269,F=1.421),LVDd差异有统计学意义(P<0.001,F=8.464);术后及随访半年后LVDd、LVEF组间比较,差异无统计学意义(P>0.05);但组内术后及随访半年与术前比较,LVDd差异有统计学意义(P<0.05),而LVEF差异无统计学意义(P>0.05);术后17例存活患者中有4例出现并发症,发生率为23.53%,经及时对症处理后,症状均得到缓解或好转。结论:根据单纯主动脉瓣关闭不全的主动脉夹层患者个体具体情况及辅助检查结果选择合适的术式可有效提高该病治疗效果。
Objective: To investigate the clinical treatment and the curative effect of aortic dissection characterized by pure aortic insufficiency. Methods: Eighty cases of aortic dissection characterized by pure aortic insufficiency were selected,surgical approach was chosen based on the degree of aortic intimal tear,sinus destruction conditions and past medical history,5 underwent aortic valvuloplasty alone,4 Wheat routine operation,9 Bentall routine operation. The curative effects were observed,left ventricular end diastolic diameter( LVDd) and left ventricular ejection fraction( LVEF) were detected,The patients were followed up for half year to observe the mortality and complications. Results: One patient died of chronic renal insufficiency,the mortality was 5. 56%; 11 cases cured,accounted for61. 1%. No statistical difference was found in preoperative LVEF values among the three groups( P =0. 269,F = 1. 421),while LVDd values among the three groups before surgery were statistically different( P < 0. 001,F = 8. 464). Six months after the surgery,LVDd and LVEF values among the three group swere not statistically different( P > 0. 05),there were statistical differences in LVDd values before and after treatment in each group( P < 0. 05),while LVEF values had no statistical difference( P > 0. 05). Four cases in 17 survival patients had complications,accounted for 23. 53%,after symptomatic treatment,symptoms were relieved or improved. Conclusions: Choosing surgical approach based on patient history and supplementary examination results can effectively improve the therapeutic effect aortic dissection characterized by pure aortic insufficiency.

关键词(KeyWords)： 主动脉夹层;主动脉瓣关闭不全;左室射血分数;主动脉瓣成形术;Wheat术;Bentall术
aortic dissection;aortic insufficiency;left ventricular ejection fraction;aortic valvuloplasty;Wheat routine surgery;Bentall routine surgery

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 刘萍;
LIU Ping;Department of Internal Medicine,Traditional Chinese Medicine Hospital of Fangshan District;

DOI: 10.19367/j.cnki.1000-2707.2015.03.030

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