全胸腔镜与开胸三尖瓣手术后患者炎症反应及心肌损伤情况的比较

目的 全胸腔镜三尖瓣手术是一种微创治疗方式，本次研究重点比较患者接受全胸腔镜及开胸三尖瓣手术后炎症反应和心肌损伤标记物的变化趋势。 方法 回顾性分析2018年1月至2019年4月前来我院手术的88例三尖瓣疾病患者男53例，年龄（49 ± 19）岁，左室射血分数（63 ± 6）%]，其中56例患者接受全胸腔镜手术（三尖瓣成形术50例），32例患者接受传统开胸手术，全部患者均接受单纯单瓣膜手术。我们将白细胞和C反应蛋白水平作为全身炎症反应的指标，将乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、天冬氨酸转氨酶和肌钙蛋白水平等作为心肌损伤的标志物。 结果 两组患者入院时各项指标无统计学差异，全身炎症反应于术后第2日达到高峰期，随后逐渐减少。腔镜组患者的炎症指标及心肌损伤标志物水平显著低于开胸组。 结论 与传统开胸三尖瓣手术相比，全胸腔镜三尖瓣手术能明显减少术后心肌损伤和全身炎症反应。

Comparison of inflammation reaction and myocardial injury between totally thoracoscopic procedure and thoracotomy tricuspid valve procedure

AIM To compare the inflammatory response and myocardial injury markers in patients receiving totally thoracoscopic or thoracotomy tricuspid valve surgery. METHODS We retrospectively analyzed 88 patients (males 53, average age 49±19 years, left ventricular ejection fraction 63±6%) with tricuspid valve diseases who came to our hospital for surgical treatment (72 cases for tricuspid valve plasty) between January 2018 and April 2019. A total of 56 patients received totally thoracoscopic procedure (50 cases for tricuspid valve plasty) and 32 cases received thoracotomy procedure. All patients underwent tricuspid valve surgery as single valve procedure. The leukocyte and C-reactive protein (CRP) levels were collected as indicators of systemic inflammatory reaction. The lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST) and troponin T(cTnT) were collected as markers of myocardial injury. RESULTS There was no statistical difference in the above mentioned indicators and markers on admission between the two groups. The systemic inflammatory reaction of both groups reached its peak on the 2nd day after operation and gradually decreased thereafter. Inflammation indexes and myocardial injury marker levels of patients in totally thoracoscopic approach group were significantly lower than those in sternotomy approach group. CONCLUSION Compared with thoracotomy tricuspid valve procedure, totally thoracoscopic tricuspid valve procedure can significantly reduce postoperative myocardial injury and systemic inflammatory response.