风湿性二尖瓣狭窄经皮二尖瓣球囊扩张术后疗效及左心房自发性超声显影的变化  

Efficacy of percutaneous balloon mitral valvuloplasty and change of LASEC in patients of rheumatic,mitral stenosis

作　　者：姚宗芹[1] 付存玉[1] 张志刚[1] 李光彩[2] 李海德[1] 

机构地区：[1]临沂市沂水中心医院心血管内科,山东省276400 [2]临沂市沂水中心医院药学部,山东省276400

出　　处：《中华临床医师杂志（电子版）》2016年第3期359-362,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察风湿性二尖瓣狭窄（RMS）经皮二尖瓣球囊扩张术（PBMV）后疗效及左心房自发性超声显影（LASEC）的变化,初步探讨PBMV对血栓前状态的影响。方法选择临沂市沂水中心医院2009年1月至2015年5月因风湿性二尖瓣狭窄行PBMV的患者43例[平均年龄（53.3±10.6）岁],且经超声心动图提示有LASEC,纳入病例组,并应用背向散射积分技术（IBS）对LASEC进行定量测定,将左心房及右心房平均IBS值相比得到左心房标化IBS值（IBS%）。术后2周复查超声心动图,记录术前及术后2周的IBS%,同时记录二尖瓣口面积（MVA）、左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVEDs）、左心房内径（LAD）、右心室舒张末期内径（RVEDd）、右心房内径（RAD）、左心房压（LAP）、跨瓣压差（△P）。选择同期住院未行PBMV且存在LASEC的风湿性二尖瓣狭窄患者[平均年龄（52.1±9.7）岁]17例纳入对照组,经十二导联心电图证实所有研究对象基础心律均为房颤心律,所有研究对象均给予华法林抗凝,INR控制在2~3之间。结果 （1）病例组PBMV术后,MVA明显增大,LVEDd、LAD明显缩小,LAP、△P下降,差别均有统计学意义（P均〈0.05）,且无一例栓塞并发症出现。（2）病例组PBMV术后IBS%值明显减小,差别有统计学意义（P〈0.05）,对照组单独华法林治疗2周后IBS%值较治疗前有减小趋势,但差别无统计学意义（P〉0.05）。（3）IBS%与MVA呈负相关,相关系数r=-0.55,相关系数检验有统计学意义（P〈0.05）;与其余指标均无明显相关性。结论 PBMV可明显增大二尖瓣口面积,改善风湿性二尖瓣狭窄患者的血流动力学指标;LASEC并非PBMV的禁忌证,PBMV可降低LASEC的IBS%值,对改善血栓前状态可能有益。Objective By studying the efficacy and LASEC（left atrial spontaneous echo contrast） of PBMV in rheumatic mitral stenosis, to explore the role of PBMV in reducing prethrombotic state. Methods To select 43 patients,（53.3±10.6） years, with RMS and LASEC from Jan. 2009 to May. 2015 in Yishui Central Hospital of Linyi as study group, and they all accepted PMBV. Echocardiography was performed to measure the IBS of left atrium and right atrium. ROI was placed in different zones of left atrium and right atrium to detect independently mean IBS. The ratio of mean IBS of left atrium and right atrium was regarded as left atrial IBS%. MVA（mitral valve area）,LVEDd（left ventricular end diastolic dimension）,LVEDs（left ventricular end systolic dimension）,LAD（left atrial dimension）,RVEDd（right ventricular end diastolic dimension）,RAD（left atrial dimension）,LAP（left atrial pressure）,ΔP（transmitral pressure gradient）,IBS% were measured before and in 2 weeks after PBMV. The control group consisted of 17 patients,（52.1±9.7） years, with RMS and LASEC, and they didn＇t undergo PBMV. All the subjects had atrial fibrillation. They all took orally Warfarin, and INR was controlled 2-3. Results（1）In the study group, MVA increased significantly in 2 weeks after PBMV, and LVEDd, LAD, LAP, ΔP decreased significantly（P〈0.05）. And there was no complication of embolism.（2）Compared to values obtained before the procedure, IBS% decreased significantly after PBMV（P〈0.05） in the study group; and there was no significant difference in control group before and after treatment（P〈0.05）.（3）IBS% had negative correlation with MVA（r=-0.55, P〈0.05）. Conclusions PBMV could enlarge MVA, improve the heart function, depress IBS% of LASEC. PMBV was associated with decrease of prethrombotic state.

关 键 词：二尖瓣狭窄 球囊扩张术 左心房自发性超声显影 背向散射积分 血栓前状态 

分 类 号：R542.5[医药卫生—心血管疾病]