超声负荷试验对26例经皮球囊二尖瓣成形术前后综合心功能评价  

Evaluation of Stress Echocardiography on Cardiac Function before and after Percutaneous Balloon Mitral Valvuloplasty in 26 Patients

作　　者：彭献波 傅向阳[2] 吕俊豪[2] 冯常森[2] 叶文胜 刘品明[2] 赵霞[2] 刘映峰[2] 陈爱华[2] 

机构地区：[1]西藏军区拉萨总医院干部科,拉萨850003 [2]第一军医大学珠江医院心内科,广州510282

出　　处：《中国临床医学》2000年第4期372-374,共3页Chinese Journal of Clinical Medicine

摘　　要：目的：研究静息及不同运动状态下心脏血流动力学及二尖瓣口面积变化，更客观、全面地评价ＰＢＭＶ术疗效。方法：静脉滴注异丙肾上腺素提高心率，模拟轻、中、重度体力活动，分别于术前、术后采用超声心动图观察ＭＶＡ、ＭＶＧ、Ｖｍａｘ、ＣＯ、ＥＦ等项指标。结果：二尖瓣狭窄患者２６例，男性９例，女性１７例，年龄３４．３±６．８岁。ＰＢＭＶ术前行超声负荷试验时随着心率逐步增快（在基础心率上提高２０～６０次／ｍｉｎ）ＭＶＧ（１４．２３±６．４４ｍｍＨｇ增至２１．８４±８．０６ｍｍＨｇ Ｐ＜０．０５）、Ｖｍａｘ（１．６５±０３８ｍ／ｓ增至２．８１±０．３６ｍ／ｓＰ＜０．０５）明显升高；ＭＶＡ（０．８９±０．３１ｃｍ２至０．９２±０．２０ｃｍ２Ｐ＞０．０５）、ＣＯ（３．９８±１．３６Ｌ／ｍｉｎ至４．７０±１１Ｌ／ｍｉｎＰ＞０．０５）、ＥＦ（５６．８±６．４％至６４．８±８．４％ Ｐ＞０．０５）无显著改变，提示二尖瓣储备、心功能储备几近丧失。ＰＢＭＶ术后静息状态下ＭＶＡ由０．８９±０．３１ｃｍ２增至２ ．０３±０．３６ｃｍ２，ＭＶＧ由１４．２３±６．４４ｍｍＨｇ下降至３．６３±１．６４ｍｍＨｇ（Ｐ＜０．０５），运动负荷状态下ＭＶＡ由２．Objective: The changes of cardiac hemodynamics and of mitral valve area at rest and in exercise conditions were investigated before and after mitral valvuloplasty. Methods: Heart rates were increased by intravenous given isoproterenol as slight, moderate and strong exercise stress. Indexes such as MVA, MVG, Vmax, CO and EF were measured by echocardiography before and after PBMV. Results: Twenty - six patients with mitral stenosis, including 9 male and 17 female, age 34. 3 ± 6. 8 years old. Before valvuloplasty, MVG (14. 23 ± 6. 44 mmHg to 21. 84 ± 8. 06 mmHg, P < 0. 05) .Vmax (1. 65 ± 0. 38 m/s to 2. 81 ± 0. 36 m/s, P < 0. 05) were significantly increased and MVA (0. 89 ± 0. 31 cm2 to 0. 92 ± 0. 20 cm2 P >0. 05) .CO(3. 98 ± 1. 36 L/min to 4. 70 ± 1. 11 L/min P >0. 05) .EF(56. 8 ± 6. 4 % to 64. 8 ± 8. 4 % P >0. 05) were not remarkbly changed by intravenous isoproterenol, which demonstrated that mitral valve reserve and cardiac function were almost lost. Instantly after PBMV, MVA increased from 0. 89 ± 0. 31 cm2 to 2. 03 ± 0. 36 cm2(P < 0. 05) and MVG decreased from 14. 23 ± 6. 44 mmHg to 3. 63 ± 1. 64 mmHg (P<0. 05) at rest, while MVA was increased from 2. 03 ± 0. 36 cm2 to 2. 48 ± 0. 40 cm2(p < 0. 05) and CO was increased from 5. 27 ± 0. 86 L/min to 10. 20 ± 0. 93 L/min (P < 0. 05) by isoproterenol stress echocardiography, which implied that mitral valve reserve and cardiac function were restored partly. Conclusion: MVA enlarged and mitral valve reserve restored partly by PBMV. Mitral valve reserve has more great value than MVA only at rest condition to evaluate cardiac function.

关 键 词：经皮球囊二尖瓣成形术 超声负荷试验 心功能 

分 类 号：R654.2[医药卫生—外科学] R540.45[医药卫生—临床医学]