二尖瓣置换术患者体外循环后早期左心室心肌舒张功能的变化  

Changes in early left ventricular myocardial diastolic function after cardiopulmonary bypass in patients undergoing mitral valve replacement

作　　者：丁杰[1] 史宏伟[1] 胡小菊[1] 赵雅梅[1] 缪娟娟[1] 葛亚力[1] 魏海燕[1] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,210006

出　　处：《中华麻醉学杂志》2014年第7期826-829,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价二尖瓣置换术患者体外循环（CPB）后早期左心室心肌舒张功能的变化.方法 择期行CPB下二尖瓣置换术患者20例,年龄40 ～ 70岁,性别不限,ASA分级Ⅱ或Ⅲ级,NYHA分级2或3级,术前左心室射血分数（LVEF） ≥45％.采用经食管超声心动图测定左心室整体和局部舒张功能.于锯胸骨前（T0）和停CPB后30 min（T30）、90 min（T90）记录HR、MAP、CVP、心脏指数（CI）、LVEF、经二尖瓣口血流多普勒舒张早期充盈波峰值（E）、经二尖瓣环舒张早期运动峰值速度（Ea）、左心室前壁、后壁心肌舒张早期运动速度（Em）及舒张晚期运动速度（Am）,并计算E/Ea比值和Em/Am比值.结果 患者CPB前后各时点血流动力学和左心室舒张功能各指标比较差异无统计学意义（P＞0.05）,患者各时点LVEF均大于50％,E/Ea比值均大于20.结论 二尖瓣置换术患者CPB后早期左心室心肌舒张功能并未进一步受损.Objective To evaluate the changes in early left ventricular myocardial diastolic function after cardiopulmonary bypass （CPB） in the patients undergoing mitral valve replacement.Methods Twenty patients of both sexes,aged 40-70 yr,of ASA physical status Ⅱ or Ⅲ （NYHA Ⅱ or Ⅲ）,with left ventricular ejection fraction （LVEF） ≥ 45 %,scheduled for elective mitral valve replacement with CPB,were enrolled in the study.Global and regional left ventricular diastolic function was measured by using TEE.After splitting of sternum and at 30 and 90 min after termination of CPB,HR,mean arterial pressure,central venous pressure,cardiac index,LVEF,early diastolic transmitral velocity （E）,early diastolic tissue velocity （Ea）,right ventricular early myocardial velocity （Em） and right ventricular late myocardial velocity （Am）.E/Ea and Em/Am ratios were calculated.Results There was no significant difference in the parameters of hemodynamics and left ventricular diastolic function at each time point before and after CPB.LVEF was greater than 50% and E/Ea ratio was greater than 20 at each time point in the patients.Conclusion There is no further damage to the early left ventricular myocardial diastolic function after CPB in the patients undergoing mitral valve replacement.

关 键 词：心室功能 左 舒张功能 二尖瓣置换术 体外循环 

分 类 号：R614[医药卫生—麻醉学]