主动脉瓣狭窄患者经导管主动脉瓣置换术后短期超声心动图和血N末端B型利钠肽原浓度变化特点分析

发布时间：2018-04-29 00:13

  本文选题：主动脉瓣狭窄 + 心脏瓣膜假体植入　； 参考：《中国循环杂志》2017年06期

【摘要】：目的:探讨主动脉瓣狭窄患者经导管主动脉瓣置换(TAVR)术后6个月内心功能、主动脉瓣跨瓣压差及血流速度特点,以明确TAVR术后心功能、主动瓣跨瓣压差的变化规律,为临床治疗提供指导信息。方法:2013-12至2015-12连续入选常规外科换瓣手术禁忌或美国胸外科医师学会(STS)评分高危、在我院成功行TAVR治疗的49例重度主动脉瓣狭窄患者。在TAVR治疗前后、术后1个月及6个月时,所有患者接受超声心动图检查和血N末端B型利钠肽原(NT-pro BNP)检测,记录左心室射血分数、主动脉瓣平均跨瓣压差、最大跨瓣压差、最大跨瓣血流速度和血NT-pro BNP浓度。TAVR术前左心室射血分数50%的患者分入心功能不全组,左心室射血分数≥50%的患者分入心功能正常组,观察两组患者TAVR术后心功能和NT-pro BNP浓度变化。结果:49例患者中,心功能不全组15例(30.6%),心功能正常组34例(69.4%)。TAVR治疗后7 d内,所有患者的左心室射血分数[(56.0±14.6)%vs(52.5±13.8)%]、主动脉瓣平均跨瓣压差[(11±5)mmH g(1 mmH g=0.133 kP a)vs(58±18)mmH g]、最大跨瓣压差([21.7±9.5)mmH g vs(93.0±28.6)mmH g]、最大跨瓣血流速度([2.3±0.5)m/s vs(4.8±0.7)m/s]、血NT-proB NP浓度[1 831(1 098~3 363)pg/ml vs 3 842(1 763~8 664)pg/ml]、主动脉瓣瓣口面积[(1.57±0.43)cm2 vs(0.58±0.23)cm2]较术前均有明显改善,差异均有统计学意义(P均0.05)。术后6个月内,患者的左心室射血分数仍持续上升,尤以心功能不全组为著;主动脉瓣平均跨瓣压差、最大跨瓣血流速度、NT-proB NP浓度较术后持续下降,纽约心脏协会心功能分级持续改善,差异均有统计学意义(P均0.05)。结论:TAVR是外科手术禁忌或STS评分高危的重度主动脉瓣狭窄患者的一种有效治疗方式,在6个月内可明显且持续改善患者的心功能,左心功能不全患者改善尤为明显。
[Abstract]:Objective: to investigate the characteristics of cardiac function, aortic valve pressure difference and blood flow velocity in patients with aortic stenosis within 6 months after transcatheter aortic valve replacement (TAVRV). To provide guidance information for clinical treatment. Methods from 2013-12 to 2015-12, 49 patients with severe aortic valve stenosis who had been successfully treated with TAVR in our hospital were enrolled in the routine surgical valve replacement surgery taboo or the American College of Thoracic Surgeons (ASS) score. Before and after TAVR, 1 month and 6 months after TAVR, all patients were examined by echocardiography and NT-pro BNPs. The left ventricular ejection fraction (LVEF), the mean transvalve pressure difference of aortic valve and the maximum transvalvular pressure difference were recorded. Patients with 50% left ventricular ejection fraction (LVEF) and 鈮，

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