摘要
目的分析不同程度的风湿性心脏病二尖瓣狭窄患者行经皮穿刺球囊二尖瓣成形术（PBMv）的近期及远期疗效。方法选择284例风湿性心脏病二尖瓣狭窄患者作为研究对象，依据Wilkins超声二尖瓣形态学评分将191例≤8分者归入A组，93例〉8分者归为B组。所有研究对象均采用改良Inoue球囊法行PBMV。对PBMV成功者术后进行至少48个月的随访，并对两组患者的临床疗效进行比较。结果A组PBMV成功率为97．9％（187／191），显著高于B组的92．5％（86／93），差异有统计学意义（P〈0．05）。术后6个月，两组各项超声心动图检查指标均较术前显著改善（P〈O．05）；与A组比较，B组患者术后6个月各指标与术前变化值中的左心房平均压[（14．31±4．79）mmHg（1mmHg=0．133kPa）比（15．42±5．14）mmHg]、跨瓣压差[（9．18±4．66）mmHg比（10．21±4．38）mmHg]、肺动脉收缩压[（26．21±8．76）mmHgl：L（32．04±9．58）mmHg]及二尖瓣12I面积[（1．01±0．16）cm2比（1．21±0．18）cm2]均较小，差异有统计学意义（P值均〈0．05）。对PBMV成功的273例患者术后均完成48—92个月的随访，两组患者于随访末的各项超声心动图检查指标均较术前显著改善（P〈0．05）；与A组比较，B组患者随访末各指标与术前变化值中的左心房平均压[（12．91±5．00）mmHg比（15．17±5．14）mmHg]、跨瓣压差[（7．26±4．58）mmHg比（9．63±4．22）mmHg]、肺动脉收缩压[（20．54±7．68）mmHg比（29．11±8．53）mmHg]及二尖瓣口面积[（0．92±0．15）cm。比（1．09±0．18）cm2]均较小，差异有统计学意义（P值均〈0．05）。随访期间32例出现再狭窄（11．7％，32／273），其中A组再狭窄率为8．0％（15／187），显著低于B组的19．8％（17／86），差异有统计学意义（P〈0．05）。结论风湿性心脏病的二尖瓣狭窄程度是决定PBMV疗效的关键因素之一。以Wilkins超声二尖瓣形态学评分为评价标准，评分低者的PBMV成功率较高，且术后近、远期疗效均较好，再狭窄率低。
Objective To analyze the impact of extent of mitral valve stenosis on the short and long- term outcome of percutaneous balloon mitral valvuloplasty （PBMV） in patients with mitral valve stenosis. Methods Two hundred and eighty-four patients with mitral valve stenosis were divided into two groups according to the Wilkins scoring system,and 191 cases whose score 8 were classified as group A,while the rest were classified as group B. All the patients were using the modified Inoue balloon method. Patients of successful PBMV were followed up at least 48 months and the efficiency was compared between two groups. Results The success rate of PBMV was 97.9%（ 187/191 ） and 92.5%（86/93） in group A and group B,there was significant difference between two groups （P 〈 0.05）. Echocardiography parameters improved significantlyin beth groups at 6 months after PBMV compared with those before PBMV （P〈 0.05）. Compared with those in group A, the changes of left atrial mean pressure [ （ 14.31 ± 4.79） mm Hg （ 1 mm Hg = 0.133 kPa） vs. （ 15.42 ± 5.14） mm Hg], across the valve pressure difference [ （9.18 ± 4.66） mm Hg vs. （ 10.21 ± 4.38） mm Hg], pulmonary arterial systolic pressure [ （26.21± 8.76） mm Hg vs. （32.04 ± 9.58） mm Hg], mitral valve orifice area [（1.01 ±0.16） cm2 vs. （1.21 ±0.18） cm2] after PBMV in group B were less （P〈 0.05）. Long-term follow-up （48-92 months） was completed in 273 successful cases and echocardiography parameters after PBMV improved significantly in both groups compared with those before PBMV during follow-up （P 〈 0.05）. Compared with those in group A, the changes of left atrial mean pressure [ （ 12.91 ± 5.00） mm Hg vs. （ 15.17 ± 5.14） mm Hg], across the valve pressure difference [ （7.26 ± 4.58） mm Hg vs. （9.63 ± 4.22） mm Hg], pulmonary arterial systolic pressure [ （20.54± 7.68） mm Hg vs. （29.11 ± 8.53） mm Hg ], mitral valve orifice area [ （0.92 ± 0.15 ） cm2 vs. （1.09 ± 0.18） cm2 ] after PBMV in group B were less （P 〈 0.05）. The incidence of mitral restenosis was also significantly higher in group B than that in group A [ 19.8%（17/86） vs. 8.0% （15/187） ], and there was significant difference （P 〈 0.05）. Conclusions The extent of mitral valve stenosis plays a key role on the outcome of PBMV in patients with mitral valve stenosis. Patients with lower echocardiography scores benefit more from PBMV than patients with higher echocardiography scores.
出处
《中国医师进修杂志》
2013年第19期7-10,共4页
Chinese Journal of Postgraduates of Medicine
关键词
二尖瓣瓣膜成形术
二尖瓣狭窄
治疗结果
Mitral valve annuloplasty
Mitral valve stenosis
Treatment outcome
