保留瓣下结构的二尖瓣置换术对风湿性二尖瓣狭窄左心室心肌的影响

发布时间：2018-04-06 21:36

本文选题：风湿性二尖瓣狭窄　切入点：保留瓣下结构　出处：《福建医科大学》2015年硕士论文

【摘要】：目的通过实时三维超声心动图(Real-time three-dimensional echocardiography RT-3DE)检测左心室心肌节段参数,评估风湿性二尖瓣狭窄患者术前左心室结构;评价保留瓣下结构的二尖瓣置换术对风湿性二尖瓣狭窄患者左心室心肌的影响。方法选取2014年10月-2014年12月福建省立医院住院经临床体检、实时三维超声心动图检查、术后病理明确诊断为风湿性二尖瓣狭窄(Rheumatic mitral stenosis RMS)的患者25例(A组),以正常健康人20例作为对照组。25例RMS患者对二尖瓣狭窄的手术方式均采用保留瓣下结构的二尖瓣置换术。此25例RMS患者术后为B组。记录患者年龄、手术前后血压、瓣口面积、术中主动脉阻断时间、总体外循环时间、术中出血量等。3组患者均采用美国GE Vivid E9超声显像仪进行二维超声心动图(Two-dimensional echocardiography 2DE)及实时三维超声心动图(RT-3DE)检查,记录2DE的左室射血分数(Left ventricular ejection fraction LVEF),左心室舒张末期容积(left ventricular end diastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end systolic volume,LVESV)、RT-3DE的手术前后的LVEF、LVEDV、LVESV、左心室心肌各节段的纵向应变值、圆周应变值、面积应变值、横向应变值。采用SPSS 19.0统计分析软件分析,每组数据均用Shapiro-Wilk检验是否符合正态性分布,如符合正态性分布则组间心功能及同步性参数比较采用两独立样本t检验,P0.05为差异有统计学意义,组内心功能及术前、术后同步性参数比较采用配对样本t检验P0.05为差异有统计学意义。如不符合正态性分布则采用秩和检验,P0.05为差异有统计学意义。结果三组二维超声的LVEF无明显变化(P0.05);RT-3DE的LVEF、LVEDV、LVESV实验组(A、B)较对照组有明显差异(P0.05);A组左心室心肌纵向应变实验组较对照组大部分节段有明显减小(P0.05),A组圆周应变、面积应变、横向应变与对照组无明显差异(P0.05)。A组与B组左心室部分心肌节段(中间段下壁等)应变有明显差异(P0.05)。结论1、通过RT-3DE对风湿性二尖瓣病人左心室心肌各节段的运动参数检测,证明风湿性二尖瓣狭窄患者术前既已出现左心室结构变化。2、手术后,后组乳头肌附着的左心室壁运动比其余左心室壁运动幅度增加。3、保留瓣下结构的二尖瓣置换(mitral valve replacement with preservation of subvalvular apparatus,MVRP)术能够较好的维持了左心室结构的完整性,防止换瓣术后左心室的过度扩张,大大降低了手术后并发症的风险。
[Abstract]:Objective to evaluate the left ventricular structure in patients with rheumatic mitral stenosis by real-time real-time three-dimensional echocardiography RT-3DED.To evaluate the effect of mitral valve replacement with preservation of subvalvular structure on left ventricular myocardium in patients with rheumatic mitral stenosis.Methods from October 2014 to December 2014, Fujian Provincial Hospital was examined by clinical examination and real-time three-dimensional echocardiography.Twenty-five patients with rheumatic mitral stenosis (rheumatic mitral stenosis RMS) were treated with mitral valve replacement with preservation of subvalvular structure in group A and 20 healthy persons as control group. 25 patients with RMS underwent subvalvular mitral valve replacement.The 25 patients with RMS were treated as group B after operation.The patient's age, blood pressure before and after operation, valve area, aortic occlusion time, total cardiopulmonary bypass time were recorded.Two-dimensional echocardiography _ (2DE2) and real-time three-dimensional echocardiography (RT-3DEE) were performed with GE Vivid E9 echocardiography.Transverse strain value.Using SPSS 19.0 statistical analysis software, the data of each group were tested by Shapiro-Wilk to test whether the normal distribution was consistent with the normal distribution, if the normal distribution, the comparison of cardiac function and synchronicity parameters between groups using two independent samples t test (P0.05) had statistical significance.The heart function and postoperative synchrony parameters were compared by paired sample t test (P0.05).If the distribution was not consistent with normal distribution, the difference was statistically significant by rank sum test (P 0.05).Results there was no significant change in LVEF in the three groups of two-dimensional ultrasound. There was significant difference in the LVEFV V V V B of the LVEFV DVV LVESV group and the control group. Compared with the control group, the longitudinal strain of left ventricular myocardium in the P0.05A group significantly decreased the circumference strain and the area strain of the left ventricular myocardium in group A, compared with that in the control group.There was no significant difference between the transverse strain and the control group. There was significant difference between group A and group B in the strain of left ventricular segment (middle inferior wall, etc.).Conclusion: 1. By measuring the motion parameters of left ventricular myocardium in patients with rheumatic mitral valve by RT-3DE, it is proved that the changes of left ventricular structure have occurred in patients with rheumatic mitral stenosis before and after operation.In the posterior group, the left ventricular wall motion with papillary muscle attachment increased by .3.The mitral replacement valve replacement with preservation of subvalvular apparatus MVRP with retaining subvalvular structure could maintain the integrity of the left ventricular structure.Prevention of overexpansion of the left ventricle after valve replacement significantly reduces the risk of postoperative complications.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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