异丙肾上腺素超声负荷试验对二尖瓣球囊扩张术后疗效的评价  

Isoproterenol stress echocardiography in assessing mitral valve reserve capacity after percutaneous balloon valvuloplasty

作　　者：傅向阳[1,2] 吕俊豪[1,2] 吴群 刘品明[1,2] 杨福庆[1,2] 唐晓明 

机构地区：[1]第一军医大学珠江医院心内科 [2]兰州解放军第一医院心内科

出　　处：《中华心血管病杂志》1998年第6期465-467,共3页Chinese Journal of Cardiology

摘　　要：目的对２４例二尖瓣狭窄患者行球囊扩张术前后作异丙肾上腺素超声心动负荷试验，拟进一步评价经皮穿刺二尖瓣球囊扩张术的疗效。方法在患者安静休息的基础心率及应用异丙肾上腺素静脉点滴后不同心率状态下测定二尖瓣口面积（ＭＶＡ）、二尖瓣跨瓣压差（ＭＶＧ）及心排血量（ＣＯ）。结果二尖瓣球囊扩张使得静息状态下的瓣口面积（０．９１±０．２８升至１．８７±０．２３ｃｍ２，Ｐ＜０．０１），跨瓣压差（１２．５±６．３降至３．９±１．９ｍｍＨｇ，Ｐ＜０．０５），及心排血量（３．９３±１．４４升至４．７３±１．０１ｌ／ｍｉｎ，Ｐ＜０．０５）发生明显变化。在球囊扩张前做异丙肾上腺素试验时，虽然随着心率加快，跨瓣压差明显升高（Ｐ＜０．０１），但瓣口面积及心排血量并无显著改善（Ｐ＞０．０５）。但球囊扩张术后再做异丙肾上腺素试验时，随着心率加快，跨瓣压差升高，瓣口面积（从１．８５±０．４８升至２．３２±０．３６ｃｍ２，Ｐ＜０．０１）及心排血量（从４．４８±１．９８升至７．５５±１．９０Ｌ／ｍｉｎ，Ｐ＜０．０１）均明显进一步改善。结论异丙肾上腺素超声负荷试验能进一步评价二尖瓣球囊扩张术后的贮备功能，且该法安全。Objective The aim of this study was to assess mitral valve area and cardiac reserve in patients with mitral stenosis after successful and uncomplicated percutaneous balloon valvuloplasty by isoproterenol stress echocardiography. Methods Twenty four patients suffering from pure rheumatic mitral stenosis with sinus rhythm (18) or FA(6) who were scheduled to receive valvulotomy underwent isoproterenol stress echocardioraphy before and after valvulplasty. Mitral valve area by direct planimetry of two dimensional echocardiography, mean transmitral pressure gradient by continuous wave Doppler echocardiography , and cardiac output by M mode echocardiography were measured at rest and after stress by isoproterenol infusion to a different heart rate. Results After valvuloplasty vitral valve area (0.91±0.28 to 1.87±0.23cm 2, P <0.01), mean transmitral pressure gradient (12.5±6.3 to 3.9±1.9mmHg, P <0.05) and cardiac output (3.93±1.44 to 4.73±1.01 L/min, P <0.05) at rest were significantly improved. Before valvuloplasty, heart rate increased under isoproterenol stress, the mean transimtral pressure gradient increased significantly ( P <0.01), but there were no significant differences in mitral valve area and cardiac output (both P >0.05). In contrast, after valvuloplasty all the 3 indices increased significantly (all P <0.01) under the same stress. Conclusion These data demonstrated that successful percutaneous balloon valvuloplasty can cause significant increase of mitral valve reserve capacity assessed by isoproterenal stress echocardiography, being a safe, feasible and non invasive means.

关 键 词：二尖瓣狭窄 气囊扩张术 异丙肾上腺素 

分 类 号：R654.2[医药卫生—外科学]