摘要
目的探讨二尖瓣形态结构对老年风湿性二尖瓣狭窄患者经皮二尖瓣球囊扩张术(PBMV)的近远期疗效的影响。方法前瞻性研究,对1996年2月至2007年6月行经皮二尖瓣球囊扩张术的老年风湿性二尖瓣狭窄患者进行10年随访,将随访资料完整的124例患者纳入本研究。根据超声心动图Wilkins评分,83例患者纳入≤8分组,41例患者纳入>8分组。测量术前、术后二尖瓣跨瓣压差(MV△P)、二尖瓣口面积(MVA)、左心房内径(LAD)、左心室收缩末期内径(LVEDs)、左心室舒张末期内径(LVEDd)、肺动脉收缩压(PAPS)、射血分数(EF)、二尖瓣返流情况。结果两组患者中,术后即刻与术前比较,MVA、EF值比术前增加,MV△P、LAD、LVEDd、LVEDs、PAPs比术前下降(均P<0.05),均无严重二尖瓣返流。术后10年随访,≤8分组患者临床效果稳定,指标与术后即刻差异无统计学意义(均P>0.05)。>8分组患者MVA、EF值比术后即刻下降,MV△P、LAD、LVEDd、LVEDs、PAPS增加(均P<0.05)。≤8分组患者术后10年美国心脏病学会(NYHA)心功能Ⅲ或Ⅳ级的发生率低于>8分组患者,26.5%(22/83)比46.3%(19/41),差异有统计学意义(χ^2=4.879,P=0.027);再狭窄率低于>8分组患者,34.9%(29/83)比61.0%(25/41),差异有统计学意义(χ^2=7.567,P=0.006)。两组中度以上二尖瓣返流的发生率[10.8%(9/83)比12.3%(5/41)]比较差异无统计学意义(χ^2=1.278,P=0.258)。结论对二尖瓣Wilkins评分≤8分的老年风湿性二尖瓣狭窄患者,PBMV近远期疗效良好。
Objective To explore the effect of mitral valve morphology on short-term and long-term outcomes in elderly patients with rheumatic mitral stenosis(MS)undergoing percutaneous balloon mitral valvuloplasty(PBMV). Methods In the prospective study, elderly patients with rheumatic mitral stenosis undergoing PBMV between February 1996 and June 2007 were followed up for 10 years.One hundred and twenty-four patients with full follow-up data were included in the study.According to echocardiography Wilkins score, 83 cases of patients(Wilkins score ≤8)were selected as Wilkins score ≤8 group, and 41 cases were selected as Wilkins score>8 group.The pressure gradient in mitral valve(MV△P), mitral valve area(MVA), left atrial diameter(LAD), left ventricular end-systolic diameter(LVESd), left ventricular end-diastolic diameter(LVEDd), pulmonary artery systolic blood pressure(sPAP), ejection fraction(EF)and mitral regurgitation were measured before and after the operation. Results In both Wilkins score ≤8 group and Wilkins score>8 groups, MVA and EF were increased immediately after PBMV operation versus before PBMV operation, and MV△P, LAD, LVEDd, LVEDs and PAPs were decreased immediately after PBMV operation versus before PBMV operation(all P<0.05). Severe mitral regurgitation was not found in both two groups.The clinical effects of the Wilkins score≤8 group were stable after 10 years, which had no significant difference in the indexes compared with those in the Wilkins score≤8 group immediately after PBMV(P>0.05). MVA and EF in the Wilkins score>8 group were decreased, and MV△P, LAD, LVEDd, LVEDs and PAPS were increased after 10 years as compared with those immediately after PBMV(P<0.05). The incidence of NYHA functional class Ⅲ or Ⅳ was lower in the Wilkins score ≤8 group than in the Wilkins score>8 group(26.5% or 22/83 vs.46.3% or 19/41,χ^2=4.879, P=0.027). And the incidence of mitral restenosis was lower in the ≤8 group than in the Wilkins score>8 group(34.9% or 29/83 vs.61.0% or 25/41,χ^2=7.567, P=0
作者
姚宗芹
周纪星
张志刚
张金祝
付存玉
Yao Zongqin;Zhou Jixing;Zhang Zhigang;Zhang Jinzhu;Fu Cunyu(Cardiology Department, Linyi Central Hospital, Linyi 276400, China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2019年第7期742-745,共4页
Chinese Journal of Geriatrics
关键词
二尖瓣
气囊扩张术
Mitral valve
Balloon dilatation
