魏一鸣

摘要：目的  观察MC3成形环治疗风湿性心脏瓣膜病合并三尖瓣关闭不全的临床疗效，分析其应用价值。方法  选择2017年6月～2019年2月于本院接受治疗的风湿性心脏瓣膜病合并三尖瓣关闭不全患者共70例，按照随机数字表法分为观察组及对照组，每组35例。对照组行DeVega成形术，观察组则行MC3成形环手术。比较两组手术前后三尖瓣反流面积（TVR）与心排出量（CO）、术后心功能分级（NYHA）与术后并发症发生率。结果  术后两组TVR较术前减小，CO较术前增高，且观察组优于对照组，差异有统计学意义（P<0.05）;观察组NYHA分级优于对照組，差异有统计学意义（P<0.05）;观察组并发症发生率低于对照组，差异有统计学意义（P<0.05）。结论  MC3成形环对风湿性心脏瓣膜病合并三尖瓣关闭不全的临床疗效确切，能有效改善三尖瓣反流，提升CO，改善心功能，且安全性较高。

关键词：风湿性心脏瓣膜病;三尖瓣关闭不全;MC3成形环;心排量;心功能

Abstract：Objective  To Deparment of observe the clinical efficacy of MC3 angioplasty in the treatment of rheumatic heart valve disease with tricuspid regurgitation， and to analyze its application value. Methods  A total of 70 patients with rheumatic heart valve disease and tricuspid regurgitation who were treated in our hospital from June 2017 to February 2019 were selected. They were divided into an observation group and a control group according to the random number table method， 35 cases in each group.The control group underwent DeVega plastic surgery， and the observation group underwent MC3 plastic ring surgery. The area of tricuspid regurgitation （TVR） and cardiac output （CO）， postoperative cardiac function classification （NYHA） and postoperative complication rates were compared between the two groups before and after surgery.Results  The TVR of the two groups decreased after the operation and the CO was higher than that before the operation， and the observation group was better than the control group， the difference was statistically significant （P<0.05）; the NYHA grade of the observation group was better than the control group， the difference was statistically significant （P<0.05）; The incidence of complications in the observation group was lower than that in the control group， the difference was statistically significant （P<0.05）.Conclusion  The MC3 angioplasty ring has a definite clinical effect on rheumatic heart valve disease combined with tricuspid insufficiency. It can effectively improve tricuspid valve regurgitation， improve CO， improve cardiac function， and is highly safe.

Key words：Rheumatic heart valve disease;Tricuspid regurgitation;MC3 annuloplasty;Cardiac output; Cardiac function

风湿性心脏瓣膜病（rheumatic heart valve disease）属器质性心脏病，常引发三尖瓣关闭不全，后者可引发体循环淤血及肝肿大。DeVega成形术是治疗三尖瓣关闭不全的常用术式，但其远期效果不佳[1]。祝岩等[2]采用MC3成形环治疗功能性三尖瓣反流，结果显示MC3成形环的三尖瓣成形效果理想。目前，关于MC3成形环对风湿性心脏瓣膜病合并三尖瓣关闭不全疗效的研究较少。本研究结合我院治疗的风湿性心脏瓣膜病合并三尖瓣关闭不全患者临床资料，分析MC3成形环在该病治疗方面的应用价值，旨在为临床应用提供依据，现报道如下。

1资料与方法

1.1一般资料  选择2017年6月～2019年2月于佳木斯市中心医院接受治疗的风湿性心脏瓣膜病合并三尖瓣关闭不全患者共70例，依照随机数字表法分为观察组及对照组，每组35例。观察组男17例，女18例;年龄50～66岁，平均年龄（58.20±5.73）岁;美国纽约心脏病协会（NYHA）心功能分级：Ⅱ级9例、Ⅲ级19例、Ⅳ级7例。……