风湿性心脏病左房室瓣狭窄合并右房室瓣反流患者中球囊扩张术的应用价值  

Percutaneous Balloon Mitral Valvuloplasty: Application Value in RHD Patients with MVS and TR

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

机构地区：[1]江西省人民医院心内科,江西省南昌市330006

出　　处：《中国全科医学》2014年第20期2349-2352,共4页Chinese General Practice

摘　　要：目的：探讨风湿性心脏病左房室瓣狭窄合并右房室瓣反流患者中左房室瓣球囊扩张术（ PBmV）的应用价值。方法选择2000年1月-2012年6月在江西省人民院因风湿性心脏病左房室瓣狭窄住院行PBmV的患者1700例，其中220例合并右房室瓣反流，男90例，女130例；年龄29～67岁，平均（47.5±7.4）岁；左房室瓣口面积0.4～1.5 cm^2，平均（0.9±0.3）cm^2；右房室瓣反流面积3.2～26.0 cm^2，平均（11.2±6.5）cm^2。以造影剂递增法扩张，扩张终点使左房压（ LAP）下降50%以上，或左心房平均压降到15 mm Hg（1 mm Hg＝0.133 kPa）以下，左房室瓣区舒张期隆隆样杂音消失或明显减轻。对于合并右房室瓣重度反流患者，联合使用利尿剂，保持每天2000 ml以上的尿量。术后2～3 d内用经胸超声心动图复查左房室瓣口面积（ mVA）、右房室瓣反流面积（ TRA）、LAP、左房直径（ LAD）、右房压（ RAP）、右房直径（ RAD）、肺动脉压（ PAP）以及左心室射血分数（ LVEF）。PBmV术后定期电话或门诊随访，随访6个月～9年，平均（75±32）个月，并在随访结束时经彩色多普勒超声心动图复查上述指标。结果220例患者PBmV后mVA较术前显著增加（P﹤0.01）。对于轻中度右房室瓣反流者，术后TRA较术前显著减少（P﹤0.01）；对于重度右房室瓣反流者，术后TRA与术前相比差别无统计学意义（P﹥0.05）。术后LAP、RAP、LAD、RAD均较术前减小，差异有统计学意义（P﹤0.01）；PAP患者从术前压力（60.6±15.5）mm Hg降低到术后的（48.2±10.3）mm Hg（P﹤0.01）。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。随访过程中，合并轻中度右房室瓣反流患者中有2例失访，合并重度右房室瓣反流患者中有2例死亡（大面积脑梗死1例，心力衰竭1例，分别在术后第6年和第8年死亡）。随�Objective To investigate the application value of percutaneous balloon mitral valvuloplasty （PBMV） in rheumatic heart disease （RHD） patients combined with mitral valve stenosis （MVS） and tricuspid regurgitation （TR）. Methods A total of 1 700 patients had PBMV due to MVS from January 2000 to June 2012, including 220 combined with TR, 90 males, 130 females, aged 29 - 67 years, averagely （47. 5 ±7.4） years old. Their mitral valvular area （MVA） was 0. 4 - 1.5 cm2, mean （0. 9±0. 3） cm2 ; tricuspid regurgitation area （TRA） 3.2 ±26.0 cm2, mean （ 11.2 ±6.5） cm2. Contract agent incremental method was used to make left atrial pressure decrease by 50% , or decrease to 15 mm Hg （ 1 mm Hg =0. 133 kPa） or less, and diastolic rumbling murmur disappeared or decreased remarkably in left atrioventrieular valve area. For those combined with right atrioventricular valve regurgitation, conjunctive use of diuretics to maintain urine output over 2 000 ml per day. Within days 2 ～ 3 after operation, transthoracic echocardiography was used to review MVA, TRA, left atrial diameter （ LAD）, right atrial diameter （RAD）, pulmonary artery pressure （PAP）, left ventricular ejection fraction （LVEF）. Telephone or outpatient follow -ups were regular after PBMV, lasting 6 -9 years, averagely （75 ±32） months. At the end of the follow -ups, the above indicators were reviewed by color Doppler echocardiography. Results In 220 patients combined with TR, MVA increased significantly after PBMV （P 〈 0. 01 ）. TRA reduced significantly in patients with mild, moderate TR （ P 〈 0. 01 ）, but there was not significant difference in patients with severe TR between post - and pre -operations （P 〉0. 05）. LAP, RAP, LAD, RAD decreased as compared with those before operation, the difference was significant （ P 〈 0. 01 ）. PAP reduced from pre - operative （60. 6± 15.5 ） mm Hg to post - operative （48. 2 ± 10. 3 ） mm Hg （ P 〈 0. 01 ）. Diastolic rumbling murmur reduced

关 键 词：风湿性心脏病 二尖瓣狭窄 三尖瓣闭锁不全 血管形成术 经腔 经皮冠状动脉 

分 类 号：R542.51[医药卫生—心血管疾病] R542.53[医药卫生—内科学]