CAJ | 학술논문

目的：探讨左心房血栓形成的影响因素，C反应蛋白(CRP )与脂蛋白(a)[Lp(a)]检测在风湿性心脏病心房颤动患者左心房血栓形成中的预防、诊断价值，外科处理。方法：选择我院2009年1月至2010年6月153例风心二尖瓣病变并行心脏外科手术治疗患者为研究对象。常规行经胸超声心动图检查测量心脏结构。空腹12 h后清晨静脉采血，其中CRP采用免疫比浊法，Lp(a)采用免疫比浊法。均在中低温体外循环心脏停跳下施行手术。术中发现血栓形成53例，术式为二尖瓣置换47例，二尖瓣成形6例，同时施行三尖瓣成形8例，左心房折叠2例。根据是否有术中发现血栓，分为血栓组、无血栓组。结果：患者术前LVEF≤45%，CRP、Lp(a)升高是左心房血栓高危因素；手术后早期死亡2例，分别死于低心排出量综合征和左心室破裂。术后并脑栓塞致右上肢功能障碍1例。随访1-1.5年，获访136例，心功能恢复良好。结论：左心房血栓形成与CRP、Lp(a)水平及LVEF显著相关，左房血栓的手术处理：彻底清除血栓，避免脑栓塞，保持左心房内壁相对完整可获得良好疗效。
목적：탐토좌심방혈전형성적영향인소，C반응단백(CRP )여지단백(a)[Lp(a)]검측재풍습성심장병심방전동환자좌심방혈전형성중적예방、진단개치，외과처리。방법：선택아원2009년1월지2010년6월153례풍심이첨판병변병행심장외과수술치료환자위연구대상。상규행경흉초성심동도검사측량심장결구。공복12 h후청신정맥채혈，기중CRP채용면역비탁법，Lp(a)채용면역비탁법。균재중저온체외순배심장정도하시행수술。술중발현혈전형성53례，술식위이첨판치환47례，이첨판성형6례，동시시행삼첨판성형8례，좌심방절첩2례。근거시부유술중발현혈전，분위혈전조、무혈전조。결과：환자술전LVEF≤45%，CRP、Lp(a)승고시좌심방혈전고위인소；수술후조기사망2례，분별사우저심배출량종합정화좌심실파렬。술후병뇌전새치우상지공능장애1례。수방1-1.5년，획방136례，심공능회복량호。결론：좌심방혈전형성여CRP、Lp(a)수평급LVEF현저상관，좌방혈전적수술처리：철저청제혈전，피면뇌전새，보지좌심방내벽상대완정가획득량호료효。
Objectives:To investigate the factors associated with left atrial(LA)thrombosis in patients with rheumatic mitral stenosis,study Plasma Lp(a)and CRP Levels and and surgery treat.Methods :From January 2009 to June 2010,153 rheumatic mitral valve disease patients were taken for study .Transthoracic echocardiography(TTE)were done.Blood samples were taken for determination of plasma Lp(a)and CRPconcentration.All patients underwent open heart surgery. They were classified according with whether there was thrombus in LAA.Results :LVEF≤45,increased level of CRP and Lp(a) are the clinical risk factors of left atrial(LA)thrombosis. Plasma Lp(a)and CRP Levels of patients with left atrial(LA)thrombosis is much higher than those without left atrial(LA)thrombosis.(P<0.05) 2 cases were dead 1 case dead from low cardiac output syndrome ,and another left ventricle rupture.Right upper extremity disfounction with crebral embolism 5 cases.36 caes among the 53 cases had follow - up of 1 - 1.5 years,Cardiac Function recovered well .No left atrial(LA)thrombosis was found with UCG.Conclusions : Left atrial(LA)thrombosis is prominently correlative with the level of CRP、Lp(a) and LVEF(P<0.05).To eradicate left atrial(LA)thrombosis,to avoid cerebral embolism and to maintain left atrialinwallgeneral management is an effective treatment option with good functional outcome .