影响球囊肺动脉瓣成形术疗效的因素和随访分析  

Factors related to results of percutaneous balloon pulmmnary valvuloplasty and long-term follow-up

作　　者：夏伟[1] 杨兴季[1] 王玉玮[1] 赵翠芬[1] 杨杰[1] 

机构地区：[1]山东大学齐鲁医院儿科

出　　处：《山东大学学报（医学版）》2003年第5期539-541,共3页Journal of Shandong University:Health Sciences

摘　　要：目的:判明影响球囊肺动脉瓣成形术(PBPV)疗效的因素和术后心脏形态学的变化。方法:用逐步回归法对82例患者术前和术后的跨瓣压差、球囊/瓣环比值、肺瓣口面积和球囊充盈时间进行分析;对术前和术后的右室腔直径、右室壁厚度和ECG的Rv1行t检验;对术前、术后和随访所测量的跨瓣压差行单因素方差分析。结果:术前跨瓣压差(12.34±0.73)kPa,术后压差(4.79±0.36)kPa,下降百分比为(59.45±2.14)%(P<0.001);设术后残余压差(A)为因变量,术前跨瓣压差(X)、球囊/瓣环比值(Y)、肺瓣口面积(Z)和球囊充盈时间(W)为自变量,得回归方程为A=13.46+0.3208X-6.9626Y-0.7535Z,R2=0.6506;42例患者得到随访,随访时间为87±26.3(38～126)个月,平均随访压差(3.73±0.42)kPa,随访压差较前明显降低(P<0.001);随访所测量的右室腔直径、右室壁厚度和ECG的Rv1较治疗前有显著良性转归(P均<0.05)。结论:PVS严重程度是影响PBPV疗效的关键因素,术后心脏形态学可以发生一定程度的好转,但大年龄患者的好转机会小于儿童。提示PVS一经确诊,即应行PBPV治疗。Objective:To discuss the factors that maybe related to the analysis of results of percutaneous balloon pulmonary valvuloplasty(PBPV)and the changes of cardiac morphology after PBPV.Methods:Multiple linear regression was used to study peak gradient,balloon-anulus ratio(BAR),pulmonary orifice area and time of inflation before and after PBPV.T test was used to study the diam-eter and thickness of the right ventricle(RV),and Rv1of EKG before and during follow-up.F test was used to determine peak gradient before and after PBPV and during follow-up.Result:82patients(age between10months and28years old,mean8.25±0.62).There was a notable reduction in the peak to peak gradient from(12.34±0.73)kPa to(4.79±0.36)kPa(P<0.001).Data of clinical and Doppler follow-up for87±26.3(38to126)months after PBPV were obtained in42patients revealing a further decrease in the gradient,3.73±0.42kPa(P<0.001).Much improvements were found in RV of diameter,and thick-ness and Rv1of EKG(P<0.05).Obtained leading to the regression equation:A=13.46+0.3208X-6.9626Y-0.7535Z(A for remnant gradient after PBPV;X for peak gradient before PBPV;Y for balloon-anulus ratio;Z for pulmonary orifice area.),R 2 =0.6506.Conclusion:The degree of pulmonary valve stenosis(PVS)is the key factor influencing the result of PBPV.Although the results of PBPV obtained during follow-up are excellent on the whole,more satistactory in morphology after PBPV have taken place in low-age children than in older ones.

关 键 词：肺动脉瓣狭窄 球囊成形术 随访 

分 类 号：R725.4[医药卫生—儿科]