右室起搏下左房压力测定指导PBMV扩张终点的研究

发布时间：2018-03-16 22:12

本文选题：二尖瓣狭窄　切入点：经皮二尖瓣球囊扩张　出处：《南昌大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨右室起搏下左房压力(LAP)变化与经皮球囊二尖瓣成形术(PBMV)的理想扩张终点的关系,为准确判断PBMV扩张终点、安全有效完成PBMV提供客观依据。方法:将42例适宜行PBMV手术的风湿性心脏病二尖瓣狭窄患者随机分为2组:对照组、右室起搏组。对照组采用球囊直径计算、心脏杂音听诊、球囊形态观察及动态观察左房压力变化确定PBMV是否到达扩张终点。右室起搏指导组于术前常规行右室快速起搏,而后按对照组方法选择扩张终点并完成PBMV。记录患者一般临床资料、心脏超声指标、心功能指标,使用SPSS13.0统计软件进行数据的统计学处理,通过组间比较和组内比较的方法,分析2组患者在PBMV前后心脏超声指标和心功能指标的改变,探讨右室起搏下左房压力变化与PBMV的理想扩张终点的关系,为安全有效完成PBMV提供更多实验依据。结果:与PBMV术前比较,2组患者术后均出现左房平均压力mLAP下降、二尖瓣瓣口面积MVA增大;术后一周6分钟步行距离(6MWT)增加,左心房内径LAD缩小;心功能评级(NYHA)提升。2组患者术后二尖瓣口面积、左心房内径、左室舒张末压力、二尖瓣跨瓣压力差、左室射血分数、6分钟步行距离及NYHA心功能评分均具有统计学差异(P㩳0.05);2组术后二尖瓣返流无明显差异。结论:PBMV术后,患者临床症状缓解,血流动力学异常明显纠正,运动耐量显著提升。其中,右室起搏组排除了不同心率及节律影响,扩张终点选择更为科学精准,扩张后效果更佳。
[Abstract]:Objective: to investigate the relationship between the changes of left atrial pressure (LAP) under right ventricular pacing and the ideal end point of percutaneous balloon mitral valvuloplasty (PBMV). Methods: 42 patients with mitral stenosis of rheumatic heart disease who were suitable for PBMV operation were randomly divided into two groups: control group and right ventricular pacing group. Balloon morphology and dynamic observation of left atrial pressure to determine whether PBMV reached the end of dilation. Then the end point of dilation was selected according to the method of control group and PBMV. the general clinical data, cardiac ultrasound index, cardiac function index were recorded, and the data were processed by SPSS13.0 statistical software, and the data were compared between groups and within groups. To investigate the relationship between left atrial pressure under right ventricular pacing and the ideal end point of PBMV, the changes of echocardiography and cardiac function were analyzed before and after PBMV in two groups. Results: compared with PBMV, the mean left atrial pressure (mLAP) decreased, the mitral valve area (MVA) increased and the walking distance (6 MW) increased 6 minutes after operation. Left atrial diameter (LAD) was reduced, cardiac function rating was increased in group 2, mitral orifice area, left atrial diameter, left ventricular end-diastolic pressure, mitral valve cross-valve pressure were poor. Left ventricular ejection fraction (LVEF) and 6-minute walking distance and NYHA cardiac function score were significantly different (P < 0.05). There was no significant difference in mitral regurgitation between the two groups. Conclusion the clinical symptoms were alleviated, hemodynamic abnormalities were corrected, and exercise tolerance was significantly improved in the two groups. The right ventricular pacing group excluded the effects of different heart rate and rhythm. The choice of expansion end point is more scientific and accurate, and the effect after expansion is better.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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