声学定量评价二尖瓣替换术保留瓣下结构对左心功能的影响  

The effects of mitral valve replacement with or without preservation of subvalvular apparatus on postoperative left ventricular function

作　　者：舒先红[1] 潘翠珍[1] 沈学东[1] 于昂[1] 黄国倩[1] 施月芳[1] 朱慧君[1] 潘文明[1] 程蕾蕾[1] 陈灏珠[1] 

机构地区：[1]上海医科大学中山医院上海市心血管病研究所,200032

出　　处：《中华超声影像学杂志》2000年第10期592-595,共4页Chinese Journal of Ultrasonography

摘　　要：目的　采用声学定量技术对慢性二尖瓣反流患者进行检测 ,旨在评价二尖瓣替换术 (MVR)保留瓣下结构对左心舒缩功能的影响。方法　根据MVR的不同方式 ,将 30例慢性二尖瓣反流患者分为3组 :A组为传统的MVR即完全切除瓣叶及其腱索患者 12例 ,B组为完全切除前叶及其腱索仅保留后叶及其腱索的MVR患者 10例 ,C组为切除部分前叶但保留前叶腱索和后叶及其腱索的MVR患者 8例。应用HPSonos 2 5 0 0声学定量技术在术前和术后 3个月分别测量左室的舒张末容积指数 (EDVI)、收缩末容积指数 (ESVI)、射血分数 (EF)、峰值射血率 (PER)、峰值充盈率 (PFR)和峰值充盈率时间 (TPFR)。结果　①术前和术后 3个月 ,三组间的心率、血压差异无显著性意义 (P >0 .0 5 )。②术前三组间的EDVI、ESVI、EF、PER、PFR和TPFR差异无显著性意义 (P >0 .0 5 )。③术后 3个月 ,A组EDVI高于术前 ,B组、C组EDVI低于术前 (均P <0 .0 5 )。A组ESVI无明显下降 ,B组、C组ESVI明显降低 (P <0 .0 5 )。A组、B组PER无明显改变 ,C组PER明显高于术前 (P <0 .0 5 )。A组、B组LVEF接近术前水平 ,C组LVEF升高 ,与术前相比差异有显著性意义 (P <0 .0 5 )。④术后 3个月 ,A组和B组的PFR和TPFR与术前比较差异无显著性意义 (P >0 .0 5 ) ,C组的PFR无明显改变 。Objective To study the effects of mitral valve replacement (MVR) with or without preservation of subvalvular apparatus on left ventricular function.Methods Thirty patients with chronic mitral regurgitation were classified into three groups. Twelve patients underwent conventional MVR (group A), 10 patients had MVR with preservation of posterior chordae tendineae only (group B), and 8 patients had MVR with preservation of both anterior and posterior chordae tendineae (group C). HP Sonos 2500 imaging system with automated border detection (ABD) technique was used to evaluate left ventricular end diastolic volume index (EDVI), end systolic volume index (ESVI), ejection fraction (EF), peak ejection rate (PER), peak fraction rate (PFR) and time of peak fraction rate (TPFR) before and three months after surgery.Results ①There were no significant difference of HR, BP or all ABD parameters among three groups before surgery (P> 0.05 ). ②After three months of surgery, EDVI was significantly greater in group A (P< 0.05 ), and lower in both group B and C (P< 0.05 ), ESVI was not changed in group A and decreased significantly in group B and C (P< 0.05 ). PER was not significantly different in group A and B and increased significantly in group C (P< 0.05 ),and EF was not significantly changed in group A and B, but improved in group C (P< 0.05 ). ③No significant difference in PFR or TPFR was found in group A or group B compared to those before surgery. However, TPFR was shorter in group C.Conclusions Conventional MVR may harm left ventricular systolic and diastolic function. MVR with preservation of both anterior and posterior chordae tendineae has more beneficial effect in maintaining or improving postoperative left ventricular systolic and diastolic function compared to MVR with preservation of posterior chordae tendineae only.

关 键 词：超声心动描记术 二尖瓣替换术 左心室功能 

分 类 号：R654.2[医药卫生—外科学]