妊娠合并风湿性二尖瓣狭窄球囊扩张治疗  

Radiation protection of pregnancy women with rheumatic heart disease combine with mitral stenosis undergoing balloon valvuloplasty

作　　者：陈章强[1] 洪浪[1] 王洪[1] 尹秋林[1] 陆林祥[1] 赖珩莉[1] 李华泰[1] 

机构地区：[1]江西省人民医院心内科,江西省心血管病研究所,南昌330006

出　　处：《临床心血管病杂志》2013年第11期871-873,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨妊娠合并风湿性心脏病二尖瓣狭窄患者球囊扩张术中的射线的防护。方法:选择风湿性心脏病二尖瓣狭窄合并妊娠患者30例,中度狭窄20例,重度狭窄10例,二尖瓣口面积平均(0.9±0.4)cm2。妊娠5～9个月。介入术前静脉使用利尿剂减轻心力衰竭症状,术中每个患者腹部及腰背部垫上防辐射铅垫子,尽量减少曝光时间和手术操作时间。结果:30例妊娠患者通过球囊扩张后,左心房平均压显著减小(P<0.01),左房室瓣跨瓣压差显著减小(P<0.01),肺动脉压力明显下降(P<0.01),二尖瓣口面积明显扩大(P<0.01);二尖瓣区舒张期隆隆样杂音从中重度减为轻度;胸闷、气促、呼吸困难等症状明显缓解,心功能明显改善。随访3个月～6年,平均(52±15)个月,密切观察下足月顺产3例,剖腹产27例,无胎儿畸型及严重并发症的发生。结论:在严格的X线屏蔽防护下,经皮穿刺球囊扩张术是妊娠合并风湿性心脏病二尖瓣中重度狭窄患者有效的治疗方法,可以减轻症状,提高生活质量,改善妊娠患者预后。Objective：To explore the radiation protection of pregnancy women with rheumatic heart disease combined with mitral stenosis undergoing balloon valvuloplasty.Method：The 30 pregnancy women suffered from rheumatic heart disease with mitral stenosis were selected in our hospital.Of them,20 cases were moderate stenosis,and 10 cases were severe stenosis.Mitral valve area was average of（0.9±0.4）cm2 in 5-9 months of pregnancy.Before intervention operative intravenous use of diuretics reduced heart failure symptoms.During procedure each patient＇s abdomen,waist and back were cushioned with anti-radiation lead pads.As far as possible we reduced exposure time and operation time.Result：In 30 cases of pregnant patients after balloon dilation,the average left atrial pressure significantly reduced（P0.01）.Left atrioventricular valve MTPG significantly reduced（P0.01）.Pulmonary artery pressure decreased significantly（P0.01）.Mitral valve area expanded significantly（P0.01）,and left atrial diameter significantly reduced（P0.01）compared with the preoperative.Chest tightness,shortness of breath,difficulty breathing and other symptoms were relieved,and cardiac function Significantly improved.Followed up for 3 months to 6 years（mean 52±15months）,under closely supervision,three cases were full-term birth,and 27 cases were caesarean section.No abnormal fetus and serious complications occurred.Conclusion：Under the X-ray strictly shielding,percutaneous balloon dilatation is an effective treatment for pregnant patients combined with severe rheumatic mitral stenosis,it can reduce symptoms and improve quality of life as well as improve the prognosis of pregnancy.

关 键 词：妊娠 风湿性心脏病二尖瓣狭窄 经皮穿刺球囊扩张术 X线防护 

分 类 号：R541.2[医药卫生—心血管疾病]