| Objective: To evaluate the effect of modified maze on early cardiac function after valve replacement,accurately evaluate the patient's cardiac function,and give appropriate treatment according to cardiac function.Methods: Clinical data from patients with mitral valve replacement(MVR)and mitral valve replacement(Cox-Maze procedure COX)who underwent cardiovascular surgery in our hospital from February 2018 to February 2019 were collected.A total of 66 patients with valvular lesions and atrial fibrillation were enrolled,of which 28 were eligible for inclusion.According to whether the patient was treated with modified maze at the same time,the patients were divided into the control group and the treatment group.The control group only underwent mitral valve replacement.The treatment group underwent modified maze surgery while performing mitral valve replacement.Analysis of operation time(min),ascending aorta block time(min),extracorporeal circulation time(min),postoperative ICU ventilator assisted breathing time(h),postoperative ICU treatment time(h),postoperative hospital stay(d)Vasoactive-inotropic score(VIS)on the day after surgery and 3 days after surgery,drainage volume(ml/h)in the 3 consecutive days after surgery,left atrial diameter before and after surgery Left Atrium diameter(LAD),left ventricular diameter(LVD),left ventricular ejection fraction(EF),left ventricular fraction shortening(FS),preoperative and postoperative Myocardial injury markers;the number of cases of postoperative atrial fibrillation rhythm in the control group and the treatment group.Results: A total of 14 patients in the treatment group,including 5 males and 9females,with an average age of 50.541±8.501 years(range,34-65 years),an average BMI of 21.526±2.102,and a total of 14 patients in the control group,including 4males and females.In 10 cases,the average age was 51.357±7.592 years old(41-69 years old),the average BMI was 21.780±2.735;in the treatment group,there were 10 cases of grade II cardiac function,4 cases of grade III cardiac function,and the heart function of the control group.There were 8 cases of grade II and 6 cases of grade III of cardiac function.The preoperative color echo of the treatment group showed that the average diameter of the left atrium and the diameter of the left ventricle were48.571±6.098(mm),49.643±9.467(mm),left ventricle.The ejection fraction and the short-axis shortening rate of the left ventricle were 0.524±0.076 and 0.271±0.047,respectively.The preoperative color of the control group was: 55.500±11.494(mm)and 51.500±8.419(mm).The left ventricular ejection fraction and left ventricular short axis shortening rate were 0.560±0.077 and 0.296±0.060,respectively;left ventricular ejection fraction and left ventricular short axis shortening rate were0.568±0.087 and 0.299±0.064,respectively;For myocardial injury markers,the average myoglobin was 23.534±9.269(ng/ml),troponin I averaged 0.051±0.046(ng/ml),type B brain natriuretic peptide averaged 1803.836±1366.578(pg/ml),and creatine kinase isoenzyme averaged 12.214±4.577(u/l)The control group was examined for myocardial injury markers before surgery.The average myoglobin was24.895±5.091(ng/ml),the troponin I was 0.048±0.030(ng/ml),and the average B-type brain natriuretic peptide was 1290.486±.567.623(pg/ml),the creatine kinase isoenzyme averaged 12.929 ± 3.647(u/l).Preoperative data of the treatment group and the control group,age,gender,preoperative cardiac function grading(NYHA classification),left atrial diameter,left ventricular diameter,left ventricular ejection fraction,left ventricular short axis shortening rate,myocardial injury There were no significant differences in the markers,and the difference was not statistically significant(P>0.05).The mean operative time of the treatment group was289.500[257.250,297.500](min),the mean time of the extracorporeal circulation was150.500[133.250,165.250](min),the mean aortic cross-blocking time was92.000[85.000,112.250](min),the average operation time of the control group was266.500[241.250,286.250](min),and the mean pump time was 120.500[95.000,143.750](min).The mean aortic cross-blocking time was 75.500[60.500,100.000](min).In the treatment group,the average ventilator assisted respiratory time,icu treatment time and postoperative hospitalization time were 31.000 [25.250,51.000](h),86.500 [63.250,129.500](h),15.000 [12.000,18.000](d),.In the control group,the average ventilator assisted respiratory time,icu treatment time and postoperative hospital stay were 23.000 [19.250,35.000](h),61.500 [47.250,94.750](h),13.500[10.750,15.250](d).Comparing the two groups of data,the average ventilator assisted breathing time and ICU treatment time in the treatment group were longer than the control group,and the difference was statistically significant(P<0.05).The drainage volume of the treatment group was 26.514±18.659,9.886±3.632,3.679±2.366(ml/h)on the day after surgery,the first day after surgery,and the second day after operation.The control group was the day after surgery and the first postoperatively.On the second day after surgery,the drainage volume in the operation area was 24.964±12.014,6.971±3.308,2.021±1.442(ml/h),respectively.Compared with the data of the two groups,there was no significant difference in the drainage volume on the day after operation(P>0.05).On the first day after surgery and the second day after surgery,the drainage volume in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in total bleeding between the two groups..In the treatment group,the color Doppler ultrasound showed that the LAD was40.429±4.164,40.500±4.451,40.500±4.470(mm),5 days after surgery,10 days after surgery,and 15 days after operation.The control group was 5 days after surgery and10 days after operation.The 15 days after operation were 45.929±7.488,45.500±7.251,45.929±7.560(mm),the LAD of the treatment group was smaller than the control group,the difference was statistically significant(P<0.05).The vasoactive and positive inotropic drug scores of the treatment group on the day after surgery,the first day after surgery,the second day after surgery,and the third day after surgery were 15.207±8.693,12.343±6.851,8.571±4.636,6.250±4.362,respectively.The vasoactive drug and positive inotropic drug scores of the control group on the day after surgery,the first day after surgery,the second day after surgery,and the third day after surgery were 17.114±7.184,14.743±5.921,10.786±5.192,7.329± 3.758,there was no statistical difference between the two groups at the same time(P>0.05).By comparing the myocardial injury markers at the same time point in the two groups,the myoglobin in the treatment group was stopped for 10 minutes.After 6h,12 h,and24h,the average was 788.629±228.599,389.050±72.968,320.721±98.685,and232.260±87.787(ng/ml).The control myoglobin was stopped for 10 minutes,and after 6h,12 h,and 24 h,the average was 549.121.±122.697,317.000±106.361,224.807±97.337,167.386±66.869(ng/ml),and the myoglobin in the treatment group was significantly higher than that in the control group,the difference was statistically significant(P<0.05);the treatment group was treated with muscle calcium.Protein I was circulated for 10 minutes,6 hours after surgery,1 2h,24 h,72h,and one week after surgery were 7.430±2.720,5.476±2.042,3.822±1.778,2.523±1.681,0.963±0.955,0.127±0.154(ng/ml),and the control group troponin I was stopped at extracorporeal circulation.10 minutes,postoperative 6h,12 h,24h,72 h,and postoperative week were 4.816±1.748,3.050±0.829,2.191±0.701,1.346±0.527,0.421±0.158,0.037±0.198(ng/ml),respectively.The troponin I in the internal treatment group was significantly higher than that in the control group(P<0.05).The CK-MB in the treatment group was 81.929±15.350(u/l)at 10 minutes of cardiopulmonary bypass,and the control group was CK-MB was 63.643±12.004(u/l)at 10 minutes of cardiopulmonary bypass,and the creatine kinase isoenzyme in the treatment group was significantly higher than that in the control group at 10 minutes of cardiopulmonary bypass(P<0.05).There was no difference in the rest of the time period(P>0.05).In the control group,14 patients were converted to sinus rhythm in12 patients,and 12 patients in the treatment group were converted to sinus rhythm.Conclusions: Although the operation of modified maze and valve replacement at the same time increased the surgical injury,the early intraoperative drainage,ventilator assisted breathing time and ICU treatment time increased,there was no significant impact on the cardiac function of the patients,and the sinus conversion rate was higher... |
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