多普勒超声心动图评价二尖瓣环成形术后瓣口狭窄程度的应用价值  

Doppler Echocardiography in Assessment of Mitral Stenosis After Mitral Annuloplasty

作　　者：邓荷萍[1] 蒲岷 

机构地区：[1]河北医科大学第三医院超声诊断,石家庄市050051 [2]美国Wake Forest大学医学中心心内科

出　　处：《中国超声医学杂志》2013年第7期588-592,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的比较二尖瓣平均跨瓣压差(PG)、连续方程法(CE)和压差降半时间法(PHT)计算二尖瓣口面积(MVA)评估二尖瓣环成形术后瓣口狭窄程度的应用价值。方法分析65例二尖瓣环成形术患者超声心动图图像,测量二尖瓣舒张期平均PG,应用CE及PHT计算MVA(MVACE、MVA-PHT)。测量二尖瓣环舒张早期运动速度(Ea),按照Ea<8 cm/s及Ea≥8 cm/s分为两组。分析PG、MVA-PHT、MVA-CE、每搏量(SV)及心率(HR)的相关性。结果 PG、MVA-CE、MVA-PHT分别为(4.92±2.19)mm Hg(1 mm Hg=0.133 kPa)、(1.92±0.46)cm^2、(2.14±0.47)cm^2。Ea≥8 cm/s组PG、MVA-CE及MVA-PHF两两间呈良好相关性,MVA-PHT与MVA-CE间差异无统计学意义[(2.11±0.37)cm^2 vs(2.06±0.41)cm^2,P=0.516]。Ea<8 cm/s组PG与MVA-CE相关性良好,MVA-PHT与PG及MVA-CE相关性差,MVA-PHT>MVA-CE[(2.17±0.53)cm^2 vs(1.81±0.47)cm^2,P=0.001]。PG与MVA、SV、HR独立相关。结论二尖瓣平均跨瓣压差、连续方程法和压差降半时间法均可用于评价二尖瓣环成形术后瓣口狭窄程度。左室舒张功能减低时(Ea<8 cm/s),连续方程法较压差降半时间法更为稳定。应用平均跨瓣压差时应注意每搏量和心率的影响。Objective The aim of the study was to compare the value of mitral diastolic pressure gradient （PG）, calculated MVA by the continuity equation （CE） and by pressure half-time （PHT） in the assessment of mitral stenosis after mitral annuloplasty. Methods 65 patients with mitral annuloplsty were studied. Mitral valve diastolic PG was measured. Mitral valve areas （MVA） were calculated using 2 different methods： the continuity equation （CE） and pressure half-time （PHT）. Mitral annulus velocity （Ea） was measured, and patients were divided into two groups ac-cording to Ea （〈8 cm/s vs ≥8 cm/s）. Relationships among PG, MVA-PHT, MVA-CE, LV stroke volume （SV） and heart rate （HR） were analyzed. Results Mean PG was （4.92±2.19） mm Hg（1 mm Hg=0. 133 kPa）. Mean MVA was （1.92±0.46） cm^2 by CE and （2.14±0.47） cm^2 by PHT respectively. In patients with Ea≥8 cm/s, MVA by PHT was significantly correlated with MVA by CE and mean PG. There was no significant difference between MVA by CE and by PHT [-（2.11±0.37） cm^2 vs （2.06±0.41） cm^2 ,P=0. 516]. In patients with Ea〈8 cm/s, there was no significant correlation between MVA by PHT and MVA by CE and no significant correlation between MVA by PHT and mean PG. In the reduced Ea group, MVA by PHT （2.17±0.53） cm^2 was significantly larger than MVA by CE [-（1.81±0.47） cm^2 , P=0. 001]. Multivariate analysis showed that mean PG was independently related to MVA, HR and SV. Conclusions All of PG, CE and PHT could be used to assess mitral stenosis after annuloplasty. In pa-tients with reduced Ea, CE was more reliable than PHT. The impact of HR and SV on PG should be taken account, when PG is used for determination of mitral stenosis.

关 键 词：超声心动描记术 多普勒 二尖瓣环成形术 二尖瓣狭窄 

分 类 号：R654.2[医药卫生—外科学]