2023 年第 3 期 第 18 卷

梗阻性肥厚型心肌病改良Morrow术同期行二尖瓣成形术患者围手术期管理效果分析

Analysis of perioperative management of patients with hypertrophic obstructive cardiomyopathy undergoing modified Morrow procedure combined with mitral valvuloplasty

作者：王艳超1许斌1王生伟2郭鸿昌2来永强2

英文作者：Wang Yanchao1 Xu Bin1 Wang Shengwei2 Guo Hongchang2 Lai Yongqiang2

单位：1首都医科大学附属北京安贞医院麻醉中心手术室，北京100029；2首都医科大学附属北京安贞医院结构性心脏病外科中心，北京100029

英文单位：1Anesthesia Center Operating Room Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Structural Cardiology Surgery Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：梗阻性肥厚型心肌病；改良Morrow术；二尖瓣成形术；围手术期管理

英文关键词：Hypertrophicobstructivecardiomyopathy;ModifiedMorrowprocedure;Mitralvalvuloplasty;Perioperativemanagement

• 摘要：

• 目的 探索行改良Morrow术的梗阻性肥厚型心肌病患者联合二尖瓣成形术的围手术期管理和效果。方法 收集2018年1月至2020年12月在首都医科大学附属北京安贞医院进行外科治疗的100例梗阻性肥厚型心肌病患者的临床资料。对患者的术前评估、术中配合以及围手术期管理等情况进行回顾性分析，根据术中是否行二尖瓣成形术将患者分为单一手术组（51例）和联合手术组（49例），比较2组围手术期相关指标差异。结果 所有患者均在全身麻醉体外循环下顺利完成手术。联合手术组3例患者心脏复跳后二尖瓣反流为中度以上关闭不全，再次进行二尖瓣成形术，效果满意。联合手术组患者体外循环时间、主动脉阻断时间、术后即刻左心室流出道压差均长于/高于单一手术组［（121±39）min比（108±47）min、（77±30）min比（64±36）min、（10.9±4.8）mmHg（1 mmHg=0.133 kPa）比（8.6±2.7）mmHg］，差异均有统计学意义（均P<0.05）。所有患者术后均无伤口渗血、出血等情况，均康复出院，出院前2组患者血红蛋白水平基本正常。联合手术组于出院前再次进行超声心动图检查，35例存在二尖瓣轻度反流、14例无反流。2组患者术后6个月随访无死亡。2组患者术后第7天血红蛋白水平、左心室舒张末期内径、左心室流出道压差、左心室射血分数及中重度二尖瓣关闭不全、术后心房颤动、心功能Ⅰ级、压力性损伤、脑梗死比例差异均无统计学意义（均P>0.05）。结论 改良Morrow术同期行二尖瓣成形术安全可行，做好患者的围手术期管理是取得良好手术疗效的重要保证。

• Objective  To explore the perioperative management and effectiveness of patients with hypertrophic obstructive cardiomyopathy(HOCM) undergoing modified Morrow procedure combined with mitral valvuloplasty. Methods  The clinical data of 100 patients with HOCM undergoing operation in Beijing Anzhen Hospital, Capital Medical University from January 2018 to December 2020 were collected. The preoperative evaluation, intraoperative cooperation and perioperative management of patients were retrospectively analyzed. Patients were divided into single operation group(51 cases) and combined operation group(49 cases) according to whether mitral valvuloplasty was performed, and the differences of perioperative related indicators were compared between the two groups. Results  All patients were successfully operated under general anesthesia and cardiopulmonary bypass. In the combined operation group after heart beating, 3 patients had mitral regurgitation caused by moderate to severe mitral insufficiency, and underwent mitral valvuloplasty again with satisfactory Results  . The cardiopulmonary bypass time, aortic occlusion time and left ventricular outflow tract gradient immediately after surgery in the combined operation group were longer/higher than those in the single operation group［（121±39）min vs （108±47）min, （77±30）min vs （64±36）min, （10.9±4.8）mmHg vs （8.6±2.7）mmHg］(all P<0.05). All patients had no wound bleeding after surgery, and were discharged from hospital after rehabilitation. Before discharge, the hemoglobin level of patients in both groups was basically normal. In the combined operation group, echocardiography was performed again before discharge. It was showed that 35 patients had mild mitral regurgitation and 14 patients had no regurgitation. There was no death in the two groups in the 6 months of follow-up after operation. There were no significant differences at the seventh day after operation in hemoglobin level, left ventricular end diastolic diameter, left ventricular outflow tract gradient, left ventricular ejection fraction, and rates of moderate to severe mitral insufficiency, postoperative atrial fibrillation, cardiac function grade Ⅰ, pressure injury, and cerebral infarction between the two groups(all P>0.05). Conclusion  Modified Morrow procedure combined with mitral valvuloplasty is safe and feasible. Good perioperative management of patients is an important guarantee for operation effect.