摘要
目的:了解经胸前超声技术对二尖瓣置换瓣术前后心脏结构、功能的变化规律,以及其对手术的评价。方法:回顾性调查2015年1月至2017年12月期间在武汉大学中南医院心胸外科行心脏单纯二尖瓣置换手术44例临床资料,根据病理改变分为二尖瓣狭窄和二尖瓣关闭不全两组,比较手术前和术后2周内心脏结构各个参数及部分血流动力学参数的变化。结果:手术前、后组间比较显示,二尖瓣狭窄组患者手术前后心脏结构测值(升主动脉、左心房、左心室)和二尖瓣口舒张期最大血流速度明显减小(P<0.05);室间隔厚度和左室后壁厚度、肺动脉宽度和左室射血分数等未见变化(P>0.05)。而二尖瓣关闭不全组手术前后心脏结构(升主动脉、左心房、左心室)和左室射血分数明显减小(P<0.05);室间隔厚度和左室后壁厚度、肺动脉宽度和二尖瓣舒张期最大血流速度等未见变化(P>0.05)。个体配对手术前后各参数差值比较的结果显示,二尖瓣狭窄组的升主动脉、左心房、左心室、肺动脉内径均缩小,其缩小幅度大于二尖瓣关闭不全组,但P>0.05,无统计学意义。从病变程度的角度分析手术前后心脏结构变化规律发现,重度狭窄或关闭不全患者,其术后心脏结构的恢复显著,轻度病变患者其术后心脏结构的恢复变化较小。结论:二尖瓣病变患者经置换手术治疗后2周内心脏各结构已显著变化,普遍向正常方向回归,经胸前超声检查能够有效评估这种心脏结构重塑;病变越重,手术前后心脏结构的变化越明显,病变越轻变化越小,提示手术前超声测量心脏结构各参数有益于恰当地把握手术时机。
Objective:To observe the changes of cardiac structure and function after prosthetic mitral valve replacement by transthoracic echocardiography,and to investigate the value of precordial echocardiography in the process.Methods:The echocardiographic dada of 44 post-mitral-replacement patients were retrospectively reviewed.The patients were divided as mitral stenosis(MS)group(n=17)and mitral regurgitation(MR)group(n=27).The changes in indices of echocardiography,such as accending aortic,left atrial and ventricleular diameter,as well as mitral peak velocities,were compared between MS and MR groups after operation.Results:After the operation,the cardiac structure(ascending aorta,left atrium,and left ventricle)and the maximum diastolic velocity of mitral valve orifice in MS group were significantly reduced(all P<0.05),while no significant changes in the thickness of interventricular septum and left posterior wall,the width of pulmonary artery and left ventricular ejection fraction(all P>0.05).In the MR group,the heart structure and left ventricular ejection fraction decreased significantly after operation(all P<0.05),and the thickness of interventricular septum and left ventricular posterior wall,the width of pulmonary artery and the maximum velocity of mitral valve diastolic flow did not change(all P>0.05).After operation,the parameters of ascending aorta,left atrium,left ventricle,and pulmonary artery in MS group were reduced,but the reduced amplitude showed no difference between the two groups(P<0.05).From the perspective of the degree of pathological changes after the operation,it was found that the recovery of cardiac structure were nore significant in severe patients,but less in the patients with mild pathological changes.Conclusion:The left sided cardiac structure demonstrably regress to normal state within two weeks after prosthetic mitral replacement for all mitral disease patients.And also,echocardiography is valuable for determining the operation time for the patients.
作者
吴晓燕
张超
曹建雷
程新耀
WU Xiaoyan;ZHANG Chao;CAO Jianlei;CHENG Xinyao(Dept.of Cardiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China;Dept.of Ultrasound Imaging,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)
出处
《武汉大学学报（医学版）》
CAS
2020年第4期657-660,共4页
Medical Journal of Wuhan University
作者简介
吴晓燕,女,1976-,医学博士,副主任医师,主要从事心衰的血流动力学和结构心脏病学的研究,E-mail:452036340@qq.com
