经皮肺动脉瓣球囊成形术三种方法的对比分析  

Comparative analysis of percutaneous balloon pulmonary valvuloplasty for pulmonary valve stenosis by three methods

作　　者：项军[1] 孟康[2] 朱耀青 朱华刚[2] 屈健[1] 

机构地区：[1]解放军九七医院内三科,江苏徐州221004 [2]北京安贞医院心内科,北京100029

出　　处：《医学研究生学报》2005年第B05期57-59,共3页Journal of Medical Postgraduates

摘　　要：目的:探讨聚乙烯单囊法、双球囊法及Inoue球囊法行经皮肺动脉瓣球囊成形术(PBPV)治疗先天性肺动脉瓣狭窄(PS)的效果及选择要点。方法:对42例先天性PS患者分别采用单囊法(n=15)、双球囊法(n=9)及In oue球囊法(n=18)行PBPV治疗,对比分析手术前后血液动力学变化及瓣膜最大开放直径。结果:PBPV术后右室收缩压、右室流出道收缩压分别由(14.69±6.01)kPa和(12.16±3.48)kPa下降至(8.14±5.26)kPa和(5.39±2.21)kPa,肺动脉收缩压由(1.57±0.56)kPa上升至(2.75±0.62)kPa。肺动脉瓣最大开放直径由术前的(8.90±2.06)Cm上升至(17.16±2.16)cm。单囊法、双球囊法及Inoue球囊法术后跨肺动脉瓣压力阶差分别为(2.40±2.05)kPa、(3.29±2.25)kPa和(2.52±1.95)kPa;收缩期右室至肺动脉总压力阶差分别为(2.40±2.05)kPa、(4.98±4.26)kPa、(6.16±6.93)kPa和(5.65±4.75)kPa。平均随访(2.5±1.6)年,超声多普勒测肺动脉瓣流速从术后的(2.38±1.89)m/s降至(2.22±1.96)m/s,跨肺动脉瓣压力阶差(3.02±1.9)kPa降低至(2.86±2.04) kPa。结论:①3种PBPV方法治疗PS均可取得较好的近期及中远期疗效。②对瓣环较小的低年龄患者,应选用聚乙烯单球囊法;而对瓣环较大、主肺动脉扩张的大龄患者应首选Inoue球囊法,聚乙烯双囊法偶可作为Inoue球囊法的补充。Objective: To evaluate the effects of percutaneous balloon pulmonary valvuloplasty ( PBPV) for pulmonary valve stenosis (PS) by single-balloon, double-balloon and Inoue-balloon methods. Methods: PBPV was performed in 42 patients with PS. The systolic right ventricular pressure (SRVP) , systolic right ventricular outflow pressure and systolic pulmonary arterial pressure ( SPAP) were contrasted before and after the procedure. Systolic transpulmonary valve pressure gradient (TVPG) and total pressure gradient from right ventricular to pulmonary arterial after the procedure were compared among the three gropes. Results:SRVP, SRVOP were decreased from (14. 69±6. 01 )kPa, (12. 16±3. 48)kPa to (8.14±5.26)kPa, (5.39±2.21)kPa and PAP increased from (1.57±0.56)cm to (17. 16± 2.16)cm after PBPV, respectively. TVPGs were (2. 40±2. 05) kPa, (3. 29±2. 25 ) kPa, (2.52± 1.95)kPa and TPGs were (2. 40±2. 05)kPa, (4.98±4.26)kPa, (6.16±6.93)kPa, (5.65±4.75) kPa after PBPV by single balloon, double balloon and Inoue balloon methods, respectively. During the follow-up period (2. 5±1. 6) years, bloodflow velocity at pulmonary valve measured by supersonic Doppler decreased from (2. 38±1. 89) m/s immediately after PBPV to (2.22±1. 96) m/s, further TVPG decreasing was indicated. Conclusion: The short and long term results of PBPV for PS by each of the three methods were excellent. Inoue balloon may be the first choice for elder children and adults, while for younger children, single balloon method may be preferred. Double balloon method can be remained as the second choice when Inoue method failed.

关 键 词：肺动脉瓣狭窄 球囊成形术 

分 类 号：R654.2[医药卫生—外科学]