小剂量多巴酚丁胺负荷超声心动图在低流速低压差伴心功能不全的主动脉瓣狭窄患者中的初步应用分析

发布时间：2018-05-28 14:58

  本文选题：超声心动描记术 + 压力　； 参考：《中国循环杂志》2017年04期

【摘要】：目的:探讨小剂量多巴酚丁胺负荷超声心动图(LDDSE)检查在主动脉瓣狭窄伴左心室功能不全、低流速低压差患者行经皮主动脉瓣置换术(TAVR)的应用价值和安全性。方法:2013-10至2016-07,在我院连续入选列为常规外科换瓣手术禁忌,且准备行TAVR适应证评估的重度主动脉瓣狭窄患者,同时合并严重左心室功能不全伴低流速低压差者,共纳入有效病例5例。记录LDDSE检查前、过程中的平均跨瓣压差、最大流速、每搏输出量、射血分数,对判定为真性重度主动脉瓣狭窄且具有左心收缩储备功能患者行TAVR治疗,无左心收缩储备功能者采取药物治疗或酌情行TAVR治疗。观察TAVR治疗后心功能和N末端B型利钠肽原(NT-pro BNP)变化。结果:5例患者均表现为LDDSE检查阳性,平均跨瓣压差均≥40mm Hg(1mm Hg=0.133k Pa),每搏输出量增加≥20%,提示患者为真性重度主动脉瓣狭窄且有心脏收缩储备功能。LDDSE过程中、结束后无明显不良反应。其中4例行经TAVR治疗,1例因暂无瓣膜等待TAVR或球囊扩张术。TAVR术后患者心功能逐渐好转或恢复至正常,NT-pro BNP持续下降。结论:低流速低压差且伴左心功能不全的重度主动脉瓣狭窄患者,可考虑行LDDSE检查明确心功能储备情况和主动脉瓣狭窄程度;如有心脏收缩功能储备,建议行TAVR治疗。TAVR是此类患者的有效治疗手段。
[Abstract]:Objective: to evaluate the value and safety of low dose dobutamine stress echocardiography (LDDSEs) in the diagnosis of aortic stenosis with left ventricular insufficiency and low flow and low pressure difference in patients undergoing percutaneous aortic valve replacement (TAVR). Methods from 2013-10 to 2016-07, the patients with severe aortic valve stenosis who were selected as contraindication of conventional surgical valve replacement surgery and who were ready to be evaluated by TAVR were included in our hospital, and the patients with severe left ventricular insufficiency with low flow and low pressure, were included in the study. Five effective cases were included. The mean transvalve pressure difference, maximum flow velocity, stroke output, ejection fraction were recorded before LDDSE examination. Patients with severe aortic stenosis and left ventricular systolic reserve function were treated with TAVR. Patients without left ventricular systolic reserve were treated with drugs or TAVR as appropriate. To observe the changes of cardiac function and N terminal B type natriuretic peptide (NT-pro) after TAVR treatment. Results all of the 5 patients were positive for LDDSE, the mean cross-valve pressure difference was 鈮，

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