二尖瓣置换术后左心室重构的临床研究

发布时间：2018-05-04 06:30

本文选题：二尖瓣狭窄 + 二尖瓣关闭不全　；参考：《昆明医科大学》2016年硕士论文

【摘要】：[目的]总结在我院行单纯二尖瓣置换术(MVR)的58例二尖瓣狭窄(MS)或二尖瓣关闭不全(MI)患者术前、术后及远期随访时左心室结构的相关超声心动图数据,比较MVR术后MS与MI患者左心室重构过程,并总结相关临床治疗经验。[方法]选择2002年8月-2015年8月在昆明医科大学第二附属医院胸心外科住院行MVR术的54例二尖瓣疾病(MS或MI)患者作为研究对象。根据其主要病变分为二尖瓣狭窄组(A组)和二尖瓣关闭不全组(B组),分别收集患者术前1周、术后1-2周及术后随访时LVD、LVEF数据,采用配对样本t检验比较患者术前、术后及远期的左心室内径和左心室射血分数。[结果]所有患者均顺利手术并出院。二尖瓣狭窄组(A组)患者的术后近期LVD(42.76±5.50mm)与术前(43.63±5.55mm)相比无显著变化(P0.05)；术后近期LVEF(62.19%±7.05%)与术前LVEF(61.58%±6.51%)相比无显著差异(P0.05)。远期随访数据显示本组远期LVD(47.47±3.31mm)较术前增加,远期LVEF(66.22%±4.4%)较术前有显著提高(P0.05)。二尖瓣关闭不全组(B组)患者术后LVD(51.29±7.56mm)与术前(58.21±9.09mm)相比显著降低(P0.05),而术后LVEF(59.08%±7.42%)较术前(61.25%±8.37%)无显著变化(P0.05)。远期随访数据显示本组LVD(47.25±5.05mm,P0.05))较术前有显著减小,远期随访LVEF(61.92%±3.75%,P0.05)与术前相比无显著变化,但与术后近期LVEF相比较有显著提高(P0.05)。[结论]1二尖瓣狭窄为主要病变的患者MVR术后近期左心室内径和射血分数与术前保持同一水平。术后远期左心室较术前增大,左室射血功能较术前明显增强。2二尖瓣关闭不全为主要病变的患者MVR术后近期左心室内径较术前减小,左室射血分数与术前保持同一水平。术后远期左心室进一步减小,左室射血分数与术前保持同一水平但较术后近期有所提高。3二尖瓣狭窄为主要病变的患者MVR术后左心室重构在远期较明显,二尖瓣关闭不全为主要病变的患者MVR术后左心室构型即有明显改变,且术后远期其左心室有进一步重构的过程。
[Abstract]:[objective] to summarize the echocardiographic data of left ventricular structure in 58 patients with mitral stenosis (MS) or mitral insufficiency (MIM) who underwent simple mitral valve replacement in our hospital. To compare the left ventricular remodeling process between MS and MI patients after MVR, and summarize the clinical experience. [methods] from August 2002 to August 2015, 54 patients with mitral valve disease (MS or MVR) who were hospitalized in thoracic and cardiac surgery, second affiliated Hospital of Kunming Medical University, were selected as the study objects. The patients were divided into mitral stenosis group (group A) and mitral valve insufficiency group (group B) according to their main lesions. LVDN LVEF data were collected 1 week before operation, 1-2 weeks after operation and follow-up after operation. Postoperative and long term left ventricular diameter and left ventricular ejection fraction. [results] all patients were successfully operated and discharged. There was no significant difference in the postoperative LVD(42.76 卤5.50mm between the patients with mitral stenosis (43.63 卤5.55mm) and the patients with mitral stenosis (62.19% 卤7.05mm), and there was no significant difference between the patients with postoperative LVEFV (61.58% 卤6.51mm) and the patients with preoperative LVEFV (61.58% 卤6.51mm). Long-term follow-up data showed that the long-term LVD(47.47 卤3.31mm in this group was higher than that before operation, and the long-term LVEF was 66.22% 卤4.4mm, which was significantly higher than that before operation (P 0.05). The postoperative LVD(51.29 卤7.56 mm of mitral valve insufficiency group (LVD(51.29 卤7.56 mm) was significantly lower than that of preoperation (58.21 卤9.09 mm), but the postoperative LVEFV 59.08% 卤7.42%) had no significant change compared with that of preoperation (61.25% 卤8.37 mm). Long-term follow-up data showed that the LVD(47.25 卤5.05 mm P0.05) was significantly lower than that before operation. The long-term follow-up showed that there was no significant change in LVEF (61.92% 卤3.75mm P0.05) compared with pre-operation, but there was a significant increase in LVEF compared with that before operation (P 0.05). [conclusion] 1 the left ventricular diameter and ejection fraction in patients with mitral stenosis were the same as those before MVR. The left ventricular ejection function and left ventricular ejection function in patients with mitral insufficiency were significantly increased in the long term after MVR. 2. The left ventricular internal diameter was decreased in the short term after MVR, and the left ventricular ejection fraction remained the same level as before operation. After MVR, left ventricular remodeling was more obvious in patients whose left ventricular ejection fraction (LVEF) remained at the same level as before operation, but increased by 3. 3 mitral stenosis as the main lesion after MVR. The left ventricular configuration of patients with mitral insufficiency was significantly changed after MVR, and the process of left ventricular remodeling occurred in the long term after MVR.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R654.2

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