二尖瓣机械瓣置换术后远期瓣环力学功能的临床研究  

The clinical study of mechanic function of mitral annulus after mitral mechanical prosthetic valve replacement

作　　者：杜国庆[1] 田家玮[1] 陈子道[2] 郑桂霞[1] 

机构地区：[1]哈尔滨医科大学附属第二医院超声科,150086 [2]哈尔滨医科大学附属第二医院心外科,150086

出　　处：《中华超声影像学杂志》2007年第6期491-494,共4页Chinese Journal of Ultrasonography

摘　　要：目的：探讨二尖瓣置换术（MVR）后瓣环力学功能的远期变化特点以及对左室重构的作用机制。方法：77例接受二尖瓣机械瓣置换术后1年以上的患者（MVR组），根据心律分为心房颤动组（房颤组）和窦性心律组（窦律组），并选取30例正常人作为对照组。应用二维和M型超声心动图对二尖瓣瓣环的运动幅度、房室腔大小以及心功能进行测量。结果：①与对照组相比，MVR组二尖瓣瓣环M型运动曲线出现异常；②MVR组二尖瓣瓣环运动幅度较对照组明显减低（P〈0.01），窦律组与房颤组之间差异无统计学意义（P〉0.05）；MVR组T波结束距瓣环峰位移时间和R波顶点距瓣环最低点时间与对照组比较有延迟（P〈0．01或P〈0．05）；③MVR组左房收缩末径较对照组扩大（P〈0．01），以房颤组更为明显；房颤组左室内径较对照组扩大（P〈0．01或P〈0.05），而射血分数（EF）和短轴缩短率（FS）则降低（P〈0．05）；窦律组左室内径、EF和FS与对照组差异无统计学意义（P〉0．05）。④二尖瓣瓣环的运动幅度与EF和FS呈正相关。结论：二尖瓣置换术后力学功能异常的瓣环在左室重构过程中起到重要的作用。Objective To assess mechanic function of mitral annulus and left ventricular remodeling after mitral valve replacement（MVR）. Methods Seventy seven patients having their implantations for more than one year were examined by echocardiography and divided into atrial fibrillation group（AF group, n = 42） and sinus rhythm group（SR group, n = 35）. An age- and sex-matched group of 30 healthy subjects were selected. Mechanic parameters of mitral annulus, dimensions of left atrium and ventricle and indexs of cardiac function were measured with echocardiography. Results ① In the MVR group, compared with control group, motion curve of mitral annulus appeared abnormally. ②The motion amplitudes of mitral annulus in MVR group were significantly decreased comparing with control group （ P 〈 0.01 ）, but there were no significant differences between SR group and AF group. The intervals between T wave of electrocardiogram and peak displacement of mitral annulus and R wave of electrocardiogram and minimum displacement of mitral annulus in MVR group were delayed（ P 〈0.01 or P 〈0.05）. ③Left atrial endsystolic diameters in MVR group, especially in AF group, were significantly increased comparing with control group （ P 〈0.01 ）. In the AF group, compared with control group, left ventricular dimensions increased whereas ejection fraction（EF） and fractional shortening（FS） decreased（ P 〈0. 01 ）, however, there were no significant differences between SR group and control group. ④There appeared positive correlation between motion amplitude of mitral annulus and EF or FS. Conclusions Abnormal mechanic function of mitral annulus after MVR may affect left ventricular remodeling.

关 键 词：超声心动描记术 二尖瓣闭锁不全 心脏瓣膜假体植入 

分 类 号：R686[医药卫生—骨科学]