经导管主动脉瓣膜植入与常规主动脉瓣膜置换手术在多风险因素主动脉瓣狭窄患者中的应用

［摘要］ 目的评价经导管主动脉瓣膜植入（transcatheter aortic valve implantation，TAVI）与常规主动脉瓣膜置换在高风险因素患者中应用的安全性及效果。 方法选择主动脉瓣狭窄患者80例，按手术方式分为常规组47例、小切口组18例和TAVI组15例。常规组采用常规开胸主动脉瓣膜置换手术，小切口组采用胸骨上段小切口主动脉瓣膜置换手术，TAVI组采用全身麻醉非体外循环下TAVI。比较3组患者手术效果及并发症发生情况。 结果小切口组24 h引流量明显少于常规组（P＜0.01）。常规组和小切口组阻断时间差异无统计学意义（P＞0.05）。小切口组手术时间、呼吸机辅助通气时间、重症监护室（intensive care unit，ICU）停留时间短于常规组，术中出血量少于常规组（P＜0.01）；TAVI组手术时间、呼吸机辅助通气时间、ICU停留时间短于常规组和小切口组，术中出血量少于常规组和小切口组，平均动脉压（mean artery pressure,MAP)变化值大于常规组和小切口组，住院费用多于常规组和小切口组（P＜0.05或P＜0.01）。3组并发症发生率差异无统计学意义（P＞0.05）。 结论TAVI手术在治疗高风险因素的患者中较常规主动脉瓣膜置换手术安全性高，创伤小，并发症少，恢复快，值得临床推广应用。

Application of transcatheter aortic valve implantation and conventional aortic valve replacement in patients with multiple risk factors of aortic stenosis

［Abstract］ObjectiveTo evaluate the safety and efficacy of transcatheter aortic valve implantation(Tavi) and conventional aortic valve replacement in patients with high risk factors. 〖WTHZ〗MethodsA retrospective analysis of 80 patients with aortic stenosis was carried out. The patients were divided into conventional group(47 cases), small incision group(18 cases) and Tavi group(15 cases). The conventional group was treated with conventional open thoracic aortic valve replacement, the small incision group was treated with upper sternum small incision aortic valve replacement, and the Tavi group was treated with general anesthesia without cardiopulmonary bypass. The operative effect and complications of the three groups were compared. 〖WTHZ〗ResultsThe drainage volume in 24 h in the small incision group was significantly lower than that in the conventional group(P＜0.01). There was no significant difference in blocking time between conventional group and small incision group(P＞0.05). The operation time, ventilator-assisted ventilation time and intensive care unit（ICU） stay time in the small incision group were shorter than those in the conventional group, and the intraoperative blood loss was less than that in the conventional group(P＜0.01). The operation time, ventilator-assisted ventilation time and ICU stay time of TAVI group were shorter than those of conventional group and small incision group, the intraoperative blood loss was less than that of conventional group and small incision group, the mean artery pressure（MAP） change value was greater than that of conventional group and small incision group, and the hospitalization cost was higher than that of conventional group and small incision group(P＜0.05 or P＜0.01). There was no significant difference in the incidence of complications among the three groups(P＞0.05). 〖WTHZ〗ConclusionTavi is more safe, less trauma, less complications and faster recovery than conventional aortic valve replacement in the treatment of patients with high risk factors.