大心脏患者左心室扩张形态与功能性二尖瓣反流关系的二维超声评价  

Echocardiographic evaluation of the relationship between pattern of left ventricular dilation and functional mitral regurgitation

作　　者：刘璐[1] 谷天祥[1] 房勤[1] 张光伟[1] LIU Lu GU Tianxiang FANG Qin ZHANG Guangwei(Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, 110001, P.R.China)

机构地区：[1]中国医科大学附属第一医院心脏外科,沈阳110001

出　　处：《中国胸心血管外科临床杂志》2017年第1期43-47,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的应用超声心动图评价大心脏患者左心室扩张形态与功能性二尖瓣反流(functional mitral regurgitation,FMR)的关系,并探讨其临床价值。方法回顾性分析2013年1月至2016年5月我院117例大心脏患者(左心室舒张期末内径≥60 mm)的临床资料,其中男78例、女39例,年龄31~77岁,按二尖瓣反流程度分为无/微量反流组(FMR-N/T组,33例)、轻度反流组(FMR-Mi组,37例)、中度反流组(FMR-Mo组,34例)和重度反流组(FMR-Se,13例)。比较各组患者的基本资料及超声心动图测值(左心室内径、容积、收缩功能、球形指数、局部室壁运动积分指数、二尖瓣隆起面积、隆起高度、前后叶成角)。结果 FMR程度越高,下壁、后壁、侧壁心肌梗死所占的比例越高(FMR-N/T vs.FMR-Mi vs.FMR-Mo vs.FMR-Se分别为12.1%vs.18.9%vs.44.1%vs.46.2%,P=0.001)、基底部运动减低或室壁瘤的发生率越高(FMR-N/T vs.FMR-Mi vs.FMR-Mo vs.FMR-Se分别为12.1%vs.27.0%vs.47.1%vs.53.8%,P=0.005);二尖瓣隆起面积、高度、二尖瓣前后叶成角、乳头肌附着区域局部室壁运动在不同FMR组间差异有统计学意义(P<0.05),并与FMR程度呈正相关。结论大心脏患者左心室局部扩张与FMR发生存在相关性。二尖瓣隆起高度、隆起面积、二尖瓣前后叶成角、乳头肌附着区域局部室壁运动指数与FMR的发生及程度呈正相关,能否改善这些指标对FMR的临床治疗决策和预后至关重要。Objective To evaluate the relationship between pattern of left ventricular dilation and functional mitral regurgitation （FMR） by echocardiography. Methods A single-center retrospective observational study was conducted on 117 patients with age of 31-77 years and left ventricular end diastolic dimension≥60 mm treated in our hospital from January 2013 through May 2016. These patients were divided into four groups by FMR degree： FMR-None/Trace （FMR-N/T group,n=33）, FMR-Minor （FMR-Mi group,n=37）, FMR-Moderate （FMR-Mo group,n=34） and FMR-Severe （FMR-Se group,n=13）. We analyzed their basic information and echocardiographic parameters including left ventricular dimension, volume, systolic function, spherical index, regional wall motion score index, tenting height and area of mitral vavle as well as anterior/posterior angle. Results The incidences of inferior/posterior/lateral myocardial infarction and basal myocardial dyskinesia/aneurysm increased with the increase of FMR degree （FMR-N/T vs. FMR-Mi vs. FMR-Mo vs. FMR-Se： 12.1% vs. 18.9% vs. 44.1% vs. 46.2%,P=0.001 and 12.1% vs. 27.0% vs.47.1% vs. 53.8%,P=0.005, respectively）. The tenting height and area of mitral valve, anterior/posterior angle, regional wall score index of the left ventricle where the papillary muscle was attached to had a positive correlation with FMR degree （P〈0.05）. Conclusion There is a relationship between regional left ventricular dilation and FMR. Evaluating and improving those parameters is very important when we choose the treatment strategy of functional mitral regurgitaion.

关 键 词：超声心动图 左心室扩张 功能性二尖瓣反流 二尖瓣成形 

分 类 号：R654.2[医药卫生—外科学]