左心房压变化对经皮球囊二尖瓣扩张术预后的预测价值  

Prognostic Value for the Changes of Left Mean Atrial Pressure in Patients With Percutaneous Balloon Mitral Valvuloplasty

作　　者：古丽娜尔.白托拉 马依彤[1] 杨毅宁[1] 谢翔[1] 付真彦[1] 武云[1] 

机构地区：[1]新疆医科大学第一附属医院心脏中心,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国循环杂志》2011年第6期454-457,共4页Chinese Circulation Journal

摘　　要：目的:研究平均左心房压(LAMP)变化对经皮球囊二尖瓣扩张术(PBMV)预后的预测价值。方法:2001-01至2006-12在我院成功行PBMV患者167例,其中105例资料完整并完成2年随访,失访患者21例,资料不完整41例。手术采用改良的Inoue球囊法。导管测定患者PBMV术前、术后LAMP,计算左心房压变化,由临床医师对患者的心功能进行评价,并于术前及术后2年行6分钟步行试验(6MWT)。应用超声心动图测定患者术前及术后2年二尖瓣瓣口面积(MVA),二尖瓣跨瓣压差(MVG)、左心室射血分数(LVEF)、左心房内径(LAD)等参数。随访时间为2年。将术后2年6分钟步行试验与术后一周6分钟步行试验对比,心脏原因导致的死亡、二尖瓣置换术、重复PBMV、心力衰竭等设为评价预后的指标。将105例患者分为预后好组(n=66)和预后差组(n=39)。结果:①预后好组与预后差组比较Wilkins评分、术后即刻二尖瓣反流程度、术前及术后2年LAMP、术前二尖瓣瓣口面积、术后2年左心房内径、术前及术后2年6分钟步行试验、术后2年肺动脉压两组间差异具有统计学意义(P<0.05～0.001)。②多元Iogistic回归分析LAMP变化、术后肺动脉压程度及术后二尖瓣反流程度纳入回归方程。结论:LAMP变化、术后肺动脉压程度及术后二尖瓣反流程度为PBMV术后预测预后的预测因素。Objective： To analyze the prognostic value for the changes of left mean atrial pressure （LMAP） in patients with percutaneous balloon mitral valvuloplasty （PBMV）. Methods ： We summarized 167 patients with PBMV in our hospital from January 2001 to December 2006. There were 105 patients with complete medical record and received 2-year follow-up study, 41 patients without complete record and 21 patients lost contact. LMAP was measured by catheter before and after PBMV. The 6 minutes walking test （6MWT） was measured before the operation, 1 week, 6 months and 2 years after the operation. Mitral valve area （MVA）, mitral valve gradient （MVG）, left atrial diameter （LAD） were measured before tile operation, 6 months and 2 years after the operation by Doppler echocardiography. The patients were＇divided into two groups： Better prognosis group, n = 66, they had no incidence of cardiac death, mitral valve replacement, repeated PBMV and heart failure, in contrast, the patients with the above mentioned conditions were defined as Worse prognosis group, n=39. Results： （1）There were statistic differences between two groups for Wilkins scores, mitral regurgitation degree right after the operation, MVA before the operation, LAD at 2 years after the operation, 6MWT before and 2 years after the operation, P〈0. 05 ~ 0. 001 respectively. （2）Logistic regression analysis included the changes of post operative LMAP, pest operative pulmonary artery pressure （PAP） and tnitral regurgitation degree for PBMV prognosis. Conclusion： The changes of LMAP, post-operative PAP and mitral regurgitation degree are predictors for PBMV prognosis.

关 键 词：二尖瓣狭窄球囊扩张 平均左心房压 6分钟步行试验 心功能 

分 类 号：R541[医药卫生—心血管疾病]