术前左心功能对二尖瓣修复术疗效的影响  

Impact of preoperative cardiac function on the outcome of mitral valve repair

作　　者：黄国倩[1] 舒先红[1] 潘翠珍[1] 陈海燕[1] 刘诗珍[1] 陈灏珠[1] 

机构地区：[1]复旦大学附属中山医院心超室上海市心血管病研究所,上海200032

出　　处：《中华超声影像学杂志》2007年第6期487-490,共4页Chinese Journal of Ultrasonography

摘　　要：目的：评价术前左心功能对二尖瓣修复术（MVR）疗效的影响。方法：对120例MVR患者随访超声心动图，根据术前左室射血分数（LVEF）将其分为：①心功能减退组34例，术前LVEF〈60％；②心功能正常组86例，术前LVEF≥60％。比较两组术后二尖瓣反流（MR）程度、左房室的大小、左室功能等指标。结果：两组性别、年龄、术前MR程度及左房内径差异均无统计学意义，但心功能减退组中合并心肌梗死或扩张型心肌病的患者较多（52．94％对1．16％，P〈0．01），且术前左室扩张更明显[左室舒张末期内径（67．29±7．88）mm对（59．20±9．14）mm，P〈0．01]。与心功能正常组相比，心功能减退组术后左室内径较大[（57．26±8．64）mm对（48．56±5．73）mm，P〈0．01]；术后MR程度较重（1．57±0．88对1．234±0．80，P〈0．05），MR的改善程度较差（1．79±0．86对2．24±0．81，P〈0．01），MR复发较多（14．71％对2．33％，P〈0．05）；术后LVEF较低[（53．00±13．25）％对（65．26±7．81）％，P〈0．01]，且心功能进一步恶化比例明显高于心功能正常组（29．41％对9．30％，P〈0．01）。结论：术前左室功能对MVR的中晚期疗效有显著影响。术前超声心动图不仅可以对二尖瓣关闭不全的病理机制作出准确诊断，还可以对左室功能进行评价，对于选择合适的手术时机具有重要价值。Objective To evaluate the influence of preoperative cardiac function on the outcome of mitral valve repair（MVR）. Methods From March 2004 to June 2006,120 patients [75 males,45 females, mean age （52.0 ±16.7）years] had received MVR and echocardiographic follow-up [（6.16 ±5.56）months]. According to their preoperative left ventricular ejection fraction （LVEF）, patients were divided into 2 groups ： dysfunction group（ group A）, preoperative LVEF〈 60 %, 34 patients ; normal function group （ group B） ,preoperative LVEF≥60% ,86 patients. The severity of mitral regurgitation（MR）,the dimensions of left ventricle（LV） and left atria（LA）, and the LVEF in the postoperative echocardiography were analyzed. Results There were no significant differences of gender, age,preoperative severity of MR and LA diameter between the 2 groups. Group A had more patients with myocardial infarction or dilated cardiomyopathy （52.94% vs 1.16% , P 〈0.01） ,the preoperative LV end-diastolic diameter （LVDd） of group A was larger than that of group B [（67.29 ± 7.88）mm vs （59.20 ±9. 14）mm, P 〈0.01]. As compared with group B,the diminution of MR,the postoperative LVEF were less in group A [AMR： 1.79±0.86 vs 2.24 ± 0.81, P 〈 0.01;LVEF （53.00± 13.25）% vs （65.26 ＋ 7.81）%, P 〈0.01],while the postoperative MR and LV dilation were more severe [MR 1.57 ± 0.88 vs 1.23 ± 0.80, P 〈0.01;LVDd： （57.26 ±8.64）mm vs （48. 56± 5. 73） mm, P 〈0.01]. In group A,there were more patients with recurrent MR （14.71% vs 2.33%, P 〈0.05）,more patients without LV size reduction （20.59%vs 6.98%, P 〈0.05）,and more patients with LVEF deterioration （29.41% vs 9.30%, P 〈0.01）. Conclusions Preoperative cardiac function had important influence on the outcome of MVR. Echocardiography could not only make an accurate diagnosis of MR pathological mechanism, but also evaluate the cardiac function, which may be helpful for clinical decision making of the optimal timing for MVR.

关 键 词：超声心动描记术 二尖瓣闭锁不全 二尖瓣修复术 

分 类 号：R686[医药卫生—骨科学]