室间隔缺损介入治疗后心脏形态的变化及培哚普利对其干预作用  

Effect of perindopril on left heart remodeling after transcatheter closure of ventricular septal defects with domestic occluder

作　　者：王晓彦[1,2] 金伟东[1] 黄国倩[3] 葛均波[3] 

机构地区：[1]无锡市第三人民医院心内科,江苏无锡214041 [2]复旦大学附属中山医院,研究生上海200032 [3]复旦大学附属中山医院心内科

出　　处：《临床心血管病杂志》2008年第12期929-932,共4页Journal of Clinical Cardiology

基　　金：上海市科委基金资助课题(No:034119903)

摘　　要：目的:观察介入治疗室间隔缺损(VSD)后心脏形态的变化规律,评价培哚普利对VSD患者封堵后左室形态、功能和肺动脉收缩压的干预影响。方法:入选经胸超声心动图(TTE)测得VSD<15.0 mm或伴有膜部瘤时基底部直径<20 mm的20例VSD患者,分成治疗组和对照组。2组均于介入治疗前1 d开始予肠溶阿司匹林200 mg/d×1个月,然后100 mg/d×5个月,治疗组加服培哚普利2 mg/d×6个月。术前,术后24 h、3个月、6个月行TTE和心电图检查,心室容积和左室射血分数采用面积长度法测定,连续多普勒根据三尖瓣反流估测肺动脉收缩压。结果:与术前相比,术后24 h左室高动力循环状态改善,左室射血分数降低(P<0.05),以后维持正常水平而保持正常左室功能。术后肺动脉收缩压虽降低,但与术前比差异均无统计学意义(P>0.05)。左房室内径、容积术后较术前差异无统计学意义(P>0.05)。治疗组经培哚普利口服6个月后,左房内径、左室内径和容积、肺动脉收缩压、左室射血分数和左室短轴缩短率与对照组相比均差异无统计学意义(P>0.05)。结论:由于膜部VSD一般均较小,术后24 h左室高动力循环状态减轻,培哚普利对左心和肺动脉压力及右心功能无影响。Objective：To assess the regular change of cardiac form and function after transcatheter closure of ventricular septal defects with domestic occluder, the effect of perindopril on left cardiac remodeling and pulmonary hypertension. Method：Twenty_two patients whose sizes of VSD were less than 15mm or less than 20mm with perimembranous aneurysm, and age were older than seventeen years, were divided into treatment group and con- trol group according to identical sex and age±5 years, two groups were regularly given Aspirin in the day before operation, 200 mg ·d 1× 1 mo, then 100 mg · d 1 × 5 mo, treatment group was also given perindopril 2 mg · d^- 1× 6 mo. Echocardiographic and electrocardiographic examinations of all patients were performed before and after closure of VSD, cardiac volume and ejection fraction were measured by area-length method, pulmonary systolic pressure by continuous wave Doppler according to tricuspid reflow. Result：Control group have no significant difference of right and left cardiac diameter and volume, FS, pulmonary diameter （PD）, pulmonary systolic pressure （PSP） between before and after closure （P〉0.05）. The left ventricular ejection fraction （LVEF） and beat volume decrease significantly between before and 24h after intervention（P〈0.05）, So hyperdynamic circulation improved. After 6-month therapy with perindopril, the improvement of left ventricular end-diastolic and end-systolic diameter, end-diastolic volume, LVEF, FS, PD, PSP were no significantly different between two groups （P〈0.05） , baseline of both groups had no significant difference （P〉0.05）. Conclusion：Only after 24 h of transcathe ter closure of VSD with domestic occluder, hyperdynamic circulation is bettered（P〉0.05）. With 6-month followup, Perindopril imposed no change on PSP, left cardiac function, size and morphology after the transcatheter closure of VSD.

关 键 词：室间隔缺损 超声心动图 介入治疗 培哚普利 左心功能 肺动脉收缩压 

分 类 号：R445.1[医药卫生—影像医学与核医学]