CAJ | 학술논문

目的观察不同瓣膜形态的二尖瓣狭窄患者行经皮球囊二尖瓣成形术的近远期疗效.方法根据Wilkins超声二尖瓣形态学积分,将385例二尖瓣狭窄患者分为＞8分组(125例)和≤8分组(260例).均采用改良Inoue法对患者行经皮球囊二尖瓣成形术.术后进行随访,并比较两组患者的临床疗效.结果经皮球囊二尖瓣成形术成功370例,＞8分组经皮球囊二尖瓣成形术的成功率低于≤8分组(92.8％比97.7％,P＜0.05).术后6个月,两组患者各项超声心动图检查指标均较术前显著改善(均P＜0.05);与≤8分组(254例)比较,＞8分组(116例)经皮球囊二尖瓣成形术后左心房平均压、肺动脉收缩压、跨瓣压差及二尖瓣瓣口面积的改变值均较小[分别为(14.22±5.02)mm Hg(1 mm Hg=0.133 kPa)比(15.44±5.19) mm Hg、(26.13±9.27) mm Hg比(31.93±9.98)mm Hg、(9.21±4.11)mm Hg比(10.16 ±4.21)mm Hg和(1.02±0.15)cm2比(1.20±0.22)cm2,均P＜0.05].经皮球囊二尖瓣成形术成功且完成远期随访[(78±20)个月]的患者共353例,两组患者各项超声心动图检查指标均较术前显著改善(均P＜0.05);与≤8分组(245例)比较,＞8分组(108例)左心房平均压、肺动脉收缩压、跨瓣压差及二尖瓣瓣口面积的改变值均较小[分别为(13.28±5.06) mm Hg比(14.77±5.17)mm Hg、(21.19±9.17) mm Hg比(28.92±9.91) mm Hg、(7.30±4.40)mm Hg比(9.16±4.28)mm Hg和(0.92±0.17)cm2比(1.07±0.20)cm2,均P＜0.05],且再狭窄发生率较高(20.4％比8.2％,P＜0.05).结论二尖瓣瓣膜形态是决定经皮球囊二尖瓣成形术疗效的关键因素之一.对于超声二尖瓣形态学积分低的患者,经皮球囊二尖瓣成形术成功率较高,术后近期及远期随访疗效较好,再狭窄发生率较低,治疗方案可优先选择经皮球囊二尖瓣成形术.
목적 관찰불동판막형태적이첨판협착환자행경피구낭이첨판성형술적근원기료효.방법 근거Wilkins초성이첨판형태학적분,장385례이첨판협착환자분위＞8분조(125례)화≤8분조(260례).균채용개량Inoue법대환자행경피구낭이첨판성형술.술후진행수방,병비교량조환자적림상료효.결과 경피구낭이첨판성형술성공370례,＞8분조경피구낭이첨판성형술적성공솔저우≤8분조(92.8％비97.7％,P＜0.05).술후6개월,량조환자각항초성심동도검사지표균교술전현저개선(균P＜0.05);여≤8분조(254례)비교,＞8분조(116례)경피구낭이첨판성형술후좌심방평균압、폐동맥수축압、과판압차급이첨판판구면적적개변치균교소[분별위(14.22±5.02)mm Hg(1 mm Hg=0.133 kPa)비(15.44±5.19) mm Hg、(26.13±9.27) mm Hg비(31.93±9.98)mm Hg、(9.21±4.11)mm Hg비(10.16 ±4.21)mm Hg화(1.02±0.15)cm2비(1.20±0.22)cm2,균P＜0.05].경피구낭이첨판성형술성공차완성원기수방[(78±20)개월]적환자공353례,량조환자각항초성심동도검사지표균교술전현저개선(균P＜0.05);여≤8분조(245례)비교,＞8분조(108례)좌심방평균압、폐동맥수축압、과판압차급이첨판판구면적적개변치균교소[분별위(13.28±5.06) mm Hg비(14.77±5.17)mm Hg、(21.19±9.17) mm Hg비(28.92±9.91) mm Hg、(7.30±4.40)mm Hg비(9.16±4.28)mm Hg화(0.92±0.17)cm2비(1.07±0.20)cm2,균P＜0.05],차재협착발생솔교고(20.4％비8.2％,P＜0.05).결론 이첨판판막형태시결정경피구낭이첨판성형술료효적관건인소지일.대우초성이첨판형태학적분저적환자,경피구낭이첨판성형술성공솔교고,술후근기급원기수방료효교호,재협착발생솔교저,치료방안가우선선택경피구낭이첨판성형술.
Objective To investigate the short and long-term outcome post percutaneous balloon mitral valvuloplasty ( PBMV ) in mitral valve stenosis patients with different mitral valve morphology.Methods Mitral valve morphology was graded according to the Wilkins scoring system,385 eligible patients were divided into echocardiographic scores ＞ 8 group ( n = 125 ) and ≤ 8 group ( n = 260).Patients were followed up after PBMV according to the improved Inoue method.Results PBMV was successful in 370 patients,the success rate of PBMV in ＞ 8 group was significantly lower than in ≤8 group (92.8％ vs.97.7％,P ＜0.05).Hemodynamic parameters improved significantly in both groups (all P ＜0.05 ) at 6 months post PBMV.Compared to pre-PBMV,improvement on left atrial mean pressure [ ( 14.22 ± 5.02) mm Hg vs.( 15.44 ± 5.19 ) mm Hg ( 1 mm Hg = 0.133 kPa) ],pulmonary artery systolic pressure [ ( 26.13 ± 9.27 )mm Hg vs.(31.93 ± 9.98 ) nun Hg ],mitral valve gradient [ (9.21 ± 4.11 ) mm Hg vs.( 10.16 ± 4.21 )mm Hg ] and area of mitral valve orifice [ ( 1.02 ± 0.15 ) cm2 vs.( 1.20 ± 0.22 ) cm2 ] post PBMV was less in ＞ 8 group ( 116 cases) than those in ≤ 8 group ( 254 cases,all P ＜ 0.05 ).Three hundreds and fifty three patients were followed up for (78 ±20) months.Echocardiographic parameters post PBMV improved significantly in both groups compared with the pre-PBMV values during follow-up (all P ＜0.05).However,left atrial mean pressure,pulmonary artery systolic pressure,mitral valve gradient and area of mitral valve orifice in ＞8 group ( 108 cases) improved less than those in ≤8 group (245 cases)[(13.28 ±5.06) mm Hg vs.(14.77 ±5.17) mm Hg,(21.19 ±9.17) mm Hg vs.(28.92 ±9.91)mm Hg,(7.30 ±4.40) mm Hgvs.(9.16±4.28) mm Hg,(0.92±0.17) cm2 vs.(1.07 ±0.20) cm2;all P ＜0.05].The incidence of mitral restenosis was also significantly higher in ＞8 group than in ≤8 group (20.4％ vs.8.2％,P ＜ 0.05 ).Conclusions The mitral valve morphology played a key role on the outcome post PBMV in patients with mitral valve stenosis.Patients with lower echocardiographic scores benefit more from PBMV than patients with higher echocardiographic scores.