二尖瓣狭窄手术前后下游流场均匀性研究  

Preand Postoperative Study of Downstream Flow Field Uniformity of Mitral Valve in Patients with Mitral Stenosis

作　　者：石应康[1] 张桂敏[1] 唐兰珍[1] 曾智[1] 

机构地区：[1]华西医科大学附属第一医院胸心外科

出　　处：《中国胸心血管外科临床杂志》1997年第4期207-211,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：客观地评价不同病变程度二尖瓣狭窄患者手术后下游流场均匀性的改善情况，探讨瓣膜病变严重性与术后流场均匀性改善之间的关系，有助于正确评估手术疗效。方法利用多普勒超声技术，对不同病变程度二尖瓣狭窄患者手术前、后二尖瓣下游流场均匀性进行对比研究。结果所有患者经皮二尖瓣球囊扩张或闭式交界分离术后，常用血流动力学指标和流场均匀性较术前有不同程度改善，但均未恢复至正常水平；术前大部分指标在两组不同病变程度二尖瓣狭窄患者间无显著差异（Ｐ＞０．０５）。术后几乎所有指标的改善程度在两组间均有显著差异（Ｐ＜０．０５）。结论术前瓣叶和瓣下结构病变的严重程度直接影响术后流场均匀性和常用血流动力学指标的恢复，病变越重，术后上述指标改善越差。研究结果提示手术干预时机应提前，否则远期疗效不佳。Objective To evaluate the improvement of downstream flow field uniformity of mitral valve in patients with mitral stenosis of varyingdegree valvular lesions after operation, and to research into the relationship between degree of valvular lesions and postoperative improvement of flow field uniformity so as to assess the real operative effect. Methods We used advanced color Doppler echocardiographic technique to conduct a comparative study of flow field uniformity downstream of mitral valve in patients with mitral stenosis of varyingdegree lesions before and after operation. Results The routine hemodynamic idems and flow field uniformities of all the patients undergone percutaneous balloon dilatation or closed commissurotomy were improved to varying degrees, but still under the normal level. Before operation, no significant difference was found in most items between the two groups of patients with varyingdegree of mitral lesions (P>0.05), but after operation significant difference was found in the improve ment of almost all items between the two groups (P<0.05). Conclusion The lesion extent of leaflets and subvalvular structures has a close relationship to the improvement of routine postoperative hemodynamic items, and flow field uniformity, the more severe the lesion is, the less improvement of routine postoperative hemodynamic items and flow field uniformity are. These results suggest that early surgical intervention is necessary or the long curative effect will not be good. The authors suggest that flow field uniformity might be used to evaluate the hemodynamic function of heart valve and operative effect as a routine and indispensable item.

关 键 词：二尖瓣狭窄 心脏外科手术 流场均匀性 

分 类 号：R654.2[医药卫生—外科学]