中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
32期
25-27
,共3页
张春曦%罗兆榴%黄达德%吴戴红
張春晞%囉兆榴%黃達德%吳戴紅
장춘희%라조류%황체덕%오대홍
心脏瓣膜假体植入%小主动脉瓣环%左心室
心髒瓣膜假體植入%小主動脈瓣環%左心室
심장판막가체식입%소주동맥판배%좌심실
Heart valve prosthesis implantation%Small aortic root%Left ventricular
目的 探讨成年人小主动脉瓣环者机械瓣膜置换术后的远期疗效,以指导临床实践.方法 2003年7月至2005年2月对36例小主动脉瓣环(直径≤19mm)的成年患者行人工机械瓣膜置换术.分别采用改良Manougnian法瓣环扩大后植入23 mm CarboMedics机械瓣膜14例(CM组);瓣环上主动脉瓣置换法直接植入19 mm CarboMedics Top Hat Supra-Annular Aortic机械瓣膜22例(CMSA组),于术前和术后6年评价两组患者的心功能,超声心动图检测左心室舒张末内径(LVDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、收缩期主动脉瓣平均跨瓣压差(PGav)、左心室短轴缩短率(LVFS),计算左心室射血分数.并抽取20例健康成年人的超声心动图数据作为对照组,对三组资料进行对比分析.结果 术后6年与术前比较,除CMSA组的IVST[(10.37±2.06)mm比(11.03±2.45)mm]和LVPWT[(10.53±2.18)mm比(11.24±3.09)mm]差异无统计学意义外,CMSA组的心功能分级、LVDD、PGav、LVEF、LVFS和CM组的全部检测指标均较术前有不同程度改·善(P＜ 0.01或＜0.05).术后6年CM组的PGav较CMSA组下降更明显[(9.24±5.93)mm Hg(1mmHg=0.133 kPa)比(24.30±12.50)mmHg],差异有统计学意义(P＜ 0.05);CM组术后6年各项指标与对照组比较差异无统计学意义,而CMSA组的IVST、LVPWT、PGav与对照组比较差异仍有统计学意义(P＜0.05).结论 成年人小主动脉瓣环者机械瓣膜置换术后远期左心室功能多恢复良好,但行瓣环扩大术应植入较大内径的瓣膜,将有利于左心室形态的逆转.
目的 探討成年人小主動脈瓣環者機械瓣膜置換術後的遠期療效,以指導臨床實踐.方法 2003年7月至2005年2月對36例小主動脈瓣環(直徑≤19mm)的成年患者行人工機械瓣膜置換術.分彆採用改良Manougnian法瓣環擴大後植入23 mm CarboMedics機械瓣膜14例(CM組);瓣環上主動脈瓣置換法直接植入19 mm CarboMedics Top Hat Supra-Annular Aortic機械瓣膜22例(CMSA組),于術前和術後6年評價兩組患者的心功能,超聲心動圖檢測左心室舒張末內徑(LVDD)、室間隔厚度(IVST)、左心室後壁厚度(LVPWT)、收縮期主動脈瓣平均跨瓣壓差(PGav)、左心室短軸縮短率(LVFS),計算左心室射血分數.併抽取20例健康成年人的超聲心動圖數據作為對照組,對三組資料進行對比分析.結果 術後6年與術前比較,除CMSA組的IVST[(10.37±2.06)mm比(11.03±2.45)mm]和LVPWT[(10.53±2.18)mm比(11.24±3.09)mm]差異無統計學意義外,CMSA組的心功能分級、LVDD、PGav、LVEF、LVFS和CM組的全部檢測指標均較術前有不同程度改·善(P＜ 0.01或＜0.05).術後6年CM組的PGav較CMSA組下降更明顯[(9.24±5.93)mm Hg(1mmHg=0.133 kPa)比(24.30±12.50)mmHg],差異有統計學意義(P＜ 0.05);CM組術後6年各項指標與對照組比較差異無統計學意義,而CMSA組的IVST、LVPWT、PGav與對照組比較差異仍有統計學意義(P＜0.05).結論 成年人小主動脈瓣環者機械瓣膜置換術後遠期左心室功能多恢複良好,但行瓣環擴大術應植入較大內徑的瓣膜,將有利于左心室形態的逆轉.
목적 탐토성년인소주동맥판배자궤계판막치환술후적원기료효,이지도림상실천.방법 2003년7월지2005년2월대36례소주동맥판배(직경≤19mm)적성년환자행인공궤계판막치환술.분별채용개량Manougnian법판배확대후식입23 mm CarboMedics궤계판막14례(CM조);판배상주동맥판치환법직접식입19 mm CarboMedics Top Hat Supra-Annular Aortic궤계판막22례(CMSA조),우술전화술후6년평개량조환자적심공능,초성심동도검측좌심실서장말내경(LVDD)、실간격후도(IVST)、좌심실후벽후도(LVPWT)、수축기주동맥판평균과판압차(PGav)、좌심실단축축단솔(LVFS),계산좌심실사혈분수.병추취20례건강성년인적초성심동도수거작위대조조,대삼조자료진행대비분석.결과 술후6년여술전비교,제CMSA조적IVST[(10.37±2.06)mm비(11.03±2.45)mm]화LVPWT[(10.53±2.18)mm비(11.24±3.09)mm]차이무통계학의의외,CMSA조적심공능분급、LVDD、PGav、LVEF、LVFS화CM조적전부검측지표균교술전유불동정도개·선(P＜ 0.01혹＜0.05).술후6년CM조적PGav교CMSA조하강경명현[(9.24±5.93)mm Hg(1mmHg=0.133 kPa)비(24.30±12.50)mmHg],차이유통계학의의(P＜ 0.05);CM조술후6년각항지표여대조조비교차이무통계학의의,이CMSA조적IVST、LVPWT、PGav여대조조비교차이잉유통계학의의(P＜0.05).결론 성년인소주동맥판배자궤계판막치환술후원기좌심실공능다회복량호,단행판배확대술응식입교대내경적판막,장유리우좌심실형태적역전.
Objective To evaluate the long-term effect after mechanical valve replacement in adult patients with small aortic root,and guide clinical practice.Methods From July 2003 to February 2005,36adult patients with small amtic root(diameter≤ 19 mm)received mechanical valve replacement,23 mm CarboMedics valve were implanted in 14 patients by using of Manougnian annulus enlargiW; technique(CM group),19 mm CarboMedics Top Hat Supra-Annular Aortic valve were implanted in 22 patients(CMSA group).All of the patients were examined for cardiac functions(CF),left ventricular end-diastolic diameter (LVDD),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),pressure gradients across aortic valve(PGav),and left ventricular fractional shortening(LVFS),calculating left ventricular ejection fraction(LVEF)before operation and 6 years after operation.Twenty healthy adults were as control group.Results Compared to the preoperation,there was no statistical difference in CMSA group in IVST[(10.37 ± 2.06)mm vs.(11.03 ± 2.45)mm]and LVPWT[(10.53 ± 2.18)mm vs.(11.24 ±degrees(P＜ 0.01 or ＜ 0.05).PGav in CM group was lower significantly than that in CMSA group after 6 years [(9.24 ±5.93)mm Hg(1 mm Hg =0.133 kPa)vs.(24.30 ± 12.50)mm Hg],the difference was statistically significant(P ＜ 0.05).The indicators in CM group were not statistically significant compared to control group,while CMSA group in IVST,LVPWT,PGav was significant difference(P ＜0.05).Conclusions The long-term effect after mechanical valve replacement is satisfied in adult patients with small aortic root,especially in left ventricular function.Line valve ring augmentation larger diameter valves implanted will help reverse the left vehicular morphology.
