小直径左房钢丝在改良经皮球囊二尖瓣成形术中的临床应用  

Clinical application of min-diameter atria steel-wire in modified percutaneous balloon mitral valvuloplasty

作　　者：王小萍[1] 廖伟[1] 邓伟[1] 

机构地区：[1]赣南医学院附属医院心内科,江西省赣州市341000

出　　处：《中国组织工程研究与临床康复》2007年第5期834-836,共3页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:评价小直径二圈半左房钢丝在改良经皮球囊二尖瓣成形术中应用的有效性、可行性和安全性。方法:选择2003-08/2005-10在赣南医学院第一附属医院住院的风湿性心脏瓣膜病二尖瓣中、重狭窄合并左心房血栓的患者63例。常规应用华法林抗凝治疗3个月以上,经华法林抗凝治疗后血栓消失8例,余血栓未消失的55例患者中,术前1周再应用小剂量尿激酶溶栓联合低分子肝素治疗5d基础上采用改良的小直径(3cm)二圈半左房钢丝及Inoue单球囊技术行经皮球囊二尖瓣成形术,观察术后即刻血流动力学改变、二尖瓣口面积,随访6个月观察肺动脉压力、左心房内径及有无栓塞并发症。结果:54例进入结果分析,中途有8例经华法林抗凝治疗后血栓消失者未纳入分析,1例因车祸死亡。①术后即刻左心房平均压和跨二尖瓣压力阶差均明显低于术前[(10.3±2.1),(28.5±3.2)mmHg,P<0.05;(3.4±2.8),(16.8±3.8)mmHg,P<0.01],二尖瓣口面积明显大于术前[(1.67±0.34),(0.86±0.26)cm2,P<0.01]。②随访6个月左心房横径明显小于术前[(46.5±4.3),(65.3±3.4)mm,P<0.01],肺动脉压力明显低于术前[(31.5±12.7),(63.8±12.3)mmHg,P<0.05]。钢丝与心脏及人体均具有高度一致的生物相容性,其标准符合ISO10993认证,术中及术后24h无一例出现排斥反应,也无血栓塞并发症发生。结论:经较充分的抗凝、溶栓治疗等术前准备,采用小直径二圈半左房钢丝及改良的Inoue单球囊技术行经皮球囊二尖瓣成形术是安全可行且有效的。AIM： To evaluate the efficacy, feasibility and safety of the min-diameter half and two convolutions atria steel-wire used in modified percutaneous balloon mitral valvuloplasty （PBMV）. METHODS： Totally 63 patients with moderate and severe mitralis stenosis of rheumatic valvular disease of the heart combined with thrombotic left auricle were enrolled from First Affiliated Hospital, Gannan Medical University between August 2003 and October 2005. After all patients received warfarin tabella for more than 3 months, thrombus disappeared in 8 patients, while other 55 patients underwent PBMV with the min-diameter （3 cm） half and two convolutions atria steel-wire and single balloon Inoue technique after low dosage urokinase intravenous drip and low molecular heparin injection for 5 days to observe the changes of hemodynamics and mitral valve orifice area after PBMV. After following-up for 6 months, pulmonary arterial pressure, inner diameter of left atrium and complication as systematic thromboembolism were observed. RESULTS： A total of 54 patients were involved in the result analysis. During the trial, 8 without thrombus after warfarin anticoagulant therapy and 1 died of traffic accident were out of the result analysis. （1）After PBMV, mean left atrial pressure （LAPm） and mean mitral valve pressure gradient （MVPG） were remarkably lower than those before PBMV [10.3±2.1） ,（28.5±3.2） mm Hg, P 〈 0.05;（3.4±2.8 ）,（16.8±3.8 ） mm Hg,P 〈 0.01]. Mitral valve orifice area（MVA）was larger distinctly than that before PBMV [（1.67±0.34 ）, （0.86±0.26） cm^2, P 〈 0.01]. （2）Six months after PBMV left atrial diameter （LAD） was smaller dramatically than that before PBMV [（46.5±4.3）,（65.3±3.4） mm,P 〈 0.01]. Pulmonary pressure （PP） was lower markedly than that before PBMV [（31.5±12.7） , （63.8 ±12.3） mm Hg, P 〈 0.05]. Steel-wire with heart and human body was in the high consistence of biocompatibility. Its standard was accorded with ISO10993. No

关 键 词：小直径 改良 二尖瓣成形术 

分 类 号：R318.08[医药卫生—生物医学工程]