超微孔膨体聚四氟乙烯人工瓣膜行绵羊二尖瓣置换的血流动力学  

Hemodynamics of sheep received mitral valve replacement with ultramicroporous expanded polytetrafluoroethylene mitral valve

作　　者：袁义[1] 蔡开灿[2] 王振康[2] 赵意[2] 张振[2] 吴华[2] 

机构地区：[1]南方医科大学附属顺德第一人民医院心胸外科,佛山市528300 [2]南方医科大学南方医院胸心血管外科,广州市510515

出　　处：《实用医学杂志》2012年第14期2318-2320,共3页The Journal of Practical Medicine

基　　金：广东省科技计划项目资助(编号:2007B030700006)

摘　　要：目的:评价自行研制的带腱索的超微孔膨体聚四氟乙烯人工无支架二尖瓣(UPMV)在体动物实验的血流动力学结果。方法:选择健康绵羊8只,在体外循环下经左心耳切口显露二尖瓣,切除瓣叶、腱索及部分乳头肌,保留乳头肌根部。将带腱索的人工柔性无支架瓣膜置入二尖瓣位置,人工腱索固定在乳头肌上。术中测定心率、血压及心排血量(CO)等循环指标,用导管直接测定左房压(PLA)、左室压(PLV),计算出平均跨瓣压差,用心脏彩超测定瓣膜的平均跨瓣压差,对两种方法测定的平均跨瓣压差进行比较。实验羊术后3周,用不同剂量的多巴酚丁胺模拟不同的运动状况下,分别测量以上指标。结果:计算出的平均跨瓣压差为(3.25±0.77)mmHg,心脏彩超测得平均跨瓣压差为(3.43±0.54)mmHg,两种方法测的平均跨瓣压差经统计学处理无显著差异。多巴酚丁胺模拟运动状态下,心排血量(CO)统计学处理差异有显著性。平均跨瓣压差、有效开口面积随心排血量的变化,统计学处理差异有显著性。返流百分比随心排血量(CO)增加而减少,统计学处理有显著差异。平均跨瓣压差显著小于国家人工瓣膜标准(<10mmHg),有效开口面积显著大于国家人工瓣膜有效开口面积标准(>1.5cm2),返流百分比显著低于国家质量检测标准(<10%)。结论:自行研制的带腱索的人工柔性无支架二尖瓣血流动力学指标满意,与体外脉动流测试结果一致,UPMV在体血流动力学特性符合国家质量人工瓣膜检测标准。Objective To evaluate the hemodynamics of sheep received mitral valve replacement with ultramicroporous expanded polytetrafluoroethylene artificial mitral valve（UPMV）.Methods Left thoracotomy was performed on eight heath sheep,the mitral valve was shown through left auricle incision,and the valve leaflet,chordae tendineae,and some part of partpapillary muscle were cut out,then the UPMV was placed into mitral orifice,and the artificial tendon was fixed on the end of papillary muscle.During the operation,the heart rate,blood pressure,and cardiac output were measured.The left atria and left ventricle pressure were measured by catheterization to calculate the mean transvalvular gradient pressure,which was compared with that detected by cardiac color ultrasonography.Athletics condition was simulated by dobutamine to measure the above indicators 3 weeks after the surgery.Results The mean transvalvular gradient pressure detected by catheterization was（3.25 ± 0.77） mmHg,and that detected by cardiac color ultrasonography was（3.43 ± 0.54） mmHg（P 0.05）.In simulated athletics condition,the cardiac output was significantly changed,and the effect orifice（which was significantly higher than the national standard, 1.5 cm2） and mean transvalvular gradient pressure（which was significantly lower than the national standard, 10 mmHg） were increased while the back flow percentage（which was significantly lower than the national standard, 10%） was decreased with the cardiac output（P 0.05）.Conclusion The hemodynamics of UPMV was well and could meet with the national standard.

关 键 词：人工心脏瓣膜 二尖瓣 超微孔膨体聚四氟乙烯人工二尖瓣 血流动力学 心脏瓣膜置换手术 

分 类 号：R654.2[医药卫生—外科学]