影响经皮二尖瓣球囊成形术术后肺动脉压力正常化的相关因素研究  

Factors determining normalization of pulmonary pressure following successful percutaneous balloon mitral valvuloplasty on mitral stenosis with pulmonary hypertension

作　　者：胡海波[1] 蒋世良[1] 戴汝平[1] 黄连军[1] 徐仲英[1] 赵世华[1] 郑宏[1] 凌坚[1] 谢若兰[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院放射科,北京100037

出　　处：《中华心血管病杂志》2002年第8期487-489,共3页Chinese Journal of Cardiology

摘　　要：目的　探讨继发性肺小动脉病变对经皮二尖瓣球囊成形术 (PBMV)术后肺动脉高压正常化的影响。方法　对 5 2 3例二尖瓣狭窄合并肺动脉高压的患者 ,PBMV术前、后测定其肺动脉收缩压 (PASP)、左房收缩压 (LASP)等血流动力学指标 ,运用多因素logistic回归分析影响术后肺动脉压正常化的因素 ,并将患者分为重度肺动脉高压组 (A组 )和非重度肺动脉高压组 (B组 )进行比较分析。结果　A组患者的PASP由术前的 (89 6 9± 16 2 7)mmHg(1mmHg =0 133kPa)下降为术后的 (5 3 0 4±16 5 2 )mmHg ,B组患者的PASP值由术前的 (48 2 3± 11 4 7)mmHg降至术后的 (33 6 4± 9 0 1)mmHg。logistic回归表明 ,术前PASP水平高是影响术后肺动脉压正常化的显著因素。A组中术后肺动脉压力下降至正常的患者比例 (4 5 % )明显低于B组 (42 5 % ) ;与B组比较 ,A组患者无论在术前、术后LASP与PASP均缺乏良好的线性关系。结论　由于继发性肺小血管改变引起的“二级狭窄”是造成PBMV术后肺动脉压力不能恢复至正常的主要原因。Objective To explore the effect of pulmonary ateriolar stenosis complicated with mitral stenosis (the secondary stenosis) on restoration of pulmonary pressure following successful percutaneous balloon mitral valvuloplasty (PBMV) Methods A total of 523 patients with pulmonary hypertension due to mitral stenosis were studied Systolic pulmonary artery pressure (PASP) and systolic left artium pressure (LASP) of them were measured by catheter pre valvuloplasty and post valvuloplasty The patients were divided into two groups: Group A including 109 patients with severe pulmonary hypertension (PASP≥70 mm Hg) pre valvuloplasty and Group B including 414 patients with mild to moderate pulmonary hypertension (PASP<70mm Hg)pre valvuloplasty The two groups were compared on hemodynamic changes after PBMV The logistic analysis was performed to evaluate the factors determining normalization of PASP after PBMV Results The level of PASP pre valvuloplasty was confirmed to be one of the most significant independent predictors of PASP normalization according to the result of logistic regression The proportion of patients with normal PASP post valvuloplasty in group A(4 5%) was much lower than that in group B(42 5%) The correlation between LASP and PASP in group B was much better than that in group A Conclusion The secondary stenosis due to anatomic changes in pulmonary arteriolar is the major factor determining normalization of pulmonary pressure following PBMV on mitral stenosis with pulmonary hypertension

关 键 词：经皮二尖瓣球囊成形术 二尖瓣狭窄 肺动脉高压 影响因素 血流动力学 

分 类 号：R654.2[医药卫生—外科学]