二尖瓣狭窄手术前后下游湍流剪应力的多普勒超声研究  

Pre-and Post-operative study of turbulent shear stress downstream of mitral stenosis by Doppler echocardiography

作　　者：张桂敏[1] 石应康[2] 唐红[3] 张尔永[2] 郭仲三[4] 樊渝波[5] 蒲放[5] 曾智[6] 

机构地区：[1]山东医科大学附属第一医院心外科,山东济南250012 [2]华西医科大学附属第一医院胸心外科 [3]华西医科大学附属第一医院彩超室 [4]中科院成都分院计算机应用研究所 [5]四川大学生物力学系 [6]华西医科大学附属第一医院心内科

出　　处：《心脏杂志》2003年第2期151-154,共4页Chinese Heart Journal

基　　金：国家自然科学基金资助项目 (3 9770 2 0 5 )

摘　　要：目的 :明确二尖瓣狭窄患者瓣膜病变及其下游湍流剪应力 (turbulentshear stress,TSS)与手术时机和预后之间的关系 ,为选择合适的诊治手段和最佳手术时机提供科学依据。方法 :应用多普勒超声与计算机图像分析技术 ,以正常人为对照 ,对一组接受经皮球囊二尖瓣狭窄扩张术或闭式二尖瓣分离术患者术前后与随访期间瓣膜下游TSS进行检测 ,同期对另一组非手术患者进行 TSS随访观测。结果 :术后 TSS较术前显著改善 (P<0 .0 5 ) ,而与正常对照相比仍有明显差距 (P<0 .0 5 )。手术患者两次随访前后 TSS等指标的增加值均显著低于非手术患者 (P<0 .0 5 )。结论 :对于中、重度二尖瓣狭窄患者 ,球囊扩张术或闭式分离术不能达到根治目的 ,但在一定程度上起到了减缓病情加重的作用。从远期疗效的角度上 ,考虑到术后残留狭窄下游 TSS仍将导致瓣膜病变进行性加重 ,建议推广超声心动图普查 ,有助于早期发现该病 ,同时可以考虑将手术时机选择在瓣膜病变早期、瓣叶和瓣下结构尚无明显损害时 ,以彻底解除瓣口狭窄、消除 TSS。AIM: To make clear the relationship between valvular lesion and turbulent shear stress (TSS) downstream of mitral valve in patients with mitral stenosis and time of operation and their prognosis so as to provide us with scientific basis for choosing suitable method of diagnosis and treatment and optimal opportunity of operation. METHODS: Using Doppler echocardiography and analysis of image by computer, with normal as control we observed TSS downstream of mitral stenosis in a group of patients before and after the operation of percutaneous balloon dilatation or closed commissurplasty and during 2 years' follow up. At the same time we also observed TSS in a group of non operative patients who completed the same period of follow up. RESULTS: Compared with preoperation, TSS in patients of post operation was significantly improved ( P <0.05). But compared with that of the control, there was a significant difference ( P <0.05). Besides, the levels of all the items in the group undergoing operation were significantly lower than that in the non operative group ( P <0.05) after follow up. CONCLUSION:The patients with moderate and severe stenosis,cannot be radically cured by both of the operations. But to a certain degree the operations slow down the progress of valvular lesion. Considering long term curative effect and postoperative TSS downstream of residual stenosis that will cause the progressive aggravation of valvular lesion, we suggest that the general investigation of echocardiography should be popularized so that the disease can be early diagnosed, and that the operations should be advanced to early time of valvular lesion when there is no obvious leaflet lesion and subvalvular structures so as to eliminate thoroughly valvular stenosis and TSS.

关 键 词：二尖瓣狭窄 手术 湍流剪应力 超声心动描记术 多普勒超声 预后 手术时机 

分 类 号：R654.2[医药卫生—外科学]