PBMV的临床效果及BNP、hs-CRP和ET-1的动态变化及意义
发布时间：2018-10-21 11:06
【摘要】：目的：探讨经皮二尖瓣狭窄球囊成形术(Percutaneous Ballon Mitral Valvuloplasty, PBMV)治疗风湿性二尖瓣狭窄患者的临床效果。PBMV前后的脑钠肽(BNP)、超敏C-反应蛋白(hs-CRP)及内皮素-1(ET-1)的动态变化及意义。方法：选择因风湿性二尖瓣狭窄在我科行经皮二尖瓣狭窄球囊成形术(PBMV)的住院患者39例,男性患者14人,女性患者25人,平均年龄为48±11.6岁,观察术前,术后10天,30天,60天行彩色多普勒超声测定二尖瓣瓣口面积(MVA)、左心房内径(LAD)等相关指标。PBMV前后测左心房压(LAP)及肺动脉压(PAP)。在相应的时间点抽取外周静脉血测血浆的BNP、Hs-CRP及ET-1浓度。结果：1,39例行PBMV患者,成功36例,成功率92.3%。2,成功行PBMV的患者36例,PBMV后即刻二尖瓣瓣口面积(MVA)较术前明显增大,术后10天,30天,60天,二尖瓣瓣口面积无显著性差异(P0.05)。PBMV后即刻左心房内径(LAD)对比术前无显著性差异,术后10天,30天,60天左心房内径(LAD)逐渐缩小,与PBMV前相比差异均有显著性(P0.01)。PBMV后即刻肺动脉压(PAP)及左房平均压(LAP)较术前明显下降。3,血浆中BNP浓度PBMV术后10天,术后30天,术后60天逐渐下降,与术前对比差异显著(P0.01)。血浆中hs-CRP浓度PBMV术后10天与术前对比无显著性差异(P0.05),术后10天,术后30天,术后60天,血浆中hs-CRP浓度逐渐下降,出现显著性差异(P0.01)。血浆中ET-1浓度PBMV术后10天与术前对比无显著性差异(P0.05),术后10天,术后30天,术后60天,血浆的ET-1浓度逐渐下降,出现显著性差异(P0.01)；4,成功行PBMV的36例患者,术后临床症状均迅速改善,患者生存质量明显提高。5,手术失败3例,包括心脏穿孔终止手术1例,瓣膜撕裂致急性左心衰终止手术1例,术中发生急性脑梗塞终止手术1例。结论：1.PBMV创伤小,术后恢复快,安全,容易被病人接受。2.PBMV能有效的扩大二尖瓣瓣口面积,降低肺动脉压及左房压,缩小左房内径,能迅速改善患者临床症状,提高患者的生存质量。3. PBMV术后生物学标记物脑钠肽(BNP)、超敏C-反应蛋白(hs-CRP)及内皮素-1(ET-1)等指标的下降可能与二尖瓣瓣口面积扩大,左心房压力下降,有效改善血流动力学有关。
[Abstract]:Objective: to investigate the clinical effect of percutaneous balloon mitral valvuloplasty (Percutaneous Ballon Mitral Valvuloplasty, PBMV) in the treatment of rheumatic mitral stenosis. The dynamic changes and significance of brain natriuretic peptide (BNP), hypersensitive C-reactive protein (hs-CRP) and endothelin-1 (ET-1) before and after PBMV. Methods: Thirty-nine patients with rheumatic mitral stenosis underwent percutaneous transluminal mitral valvuloplasty (PBMV) in our department. 14 male and 25 female patients with mean age of 48 卤11.6 years were selected. The mitral valve area (MVA), left atrial diameter (LAD), left atrial pressure (LAP) and pulmonary artery pressure (PAP).) were measured by color Doppler echocardiography 10 days, 30 days and 60 days after operation. The left atrial pressure (LAP) and pulmonary artery pressure (PAP).) were measured before and after PBMV. The concentrations of BNP,Hs-CRP and ET-1 in plasma were measured by peripheral venous blood samples at the corresponding time points. Results: (1) in 39 cases of PBMV, 36 cases were successful, and the success rate was 92.3%. 36 cases were treated with PBMV successfully. Immediately after PBMV, the mitral valve area (MVA) was significantly larger than that before PBMV, 10 days, 30 days, 60 days after PBMV. There was no significant difference in the area of mitral valve orifice (P0.05) immediately after). PBMV, there was no significant difference in left atrial diameter (LAD), but (LAD) gradually decreased at 10, 30 and 60 days after operation. There were significant differences in pulmonary artery pressure (PAP) and left atrial mean pressure (LAP) between before and after PBMV (P0.01). PBMV). The plasma BNP concentration decreased gradually 10 days after PBMV, 30 days after operation and 60 days after operation (P0.01). There was no significant difference in plasma hs-CRP concentration between 10 days after operation and 10 days after operation (P0.05). After 10 days, 30 days after operation, 60 days after operation, the plasma hs-CRP concentration gradually decreased, there was a significant difference (P0.01). There was no significant difference in plasma ET-1 concentration between 10 days after operation and 10 days after operation (P0.05). After 10 days, 30 days after operation, 60 days after operation, the plasma ET-1 concentration gradually decreased, there was significant difference (P0.01). The postoperative clinical symptoms were improved rapidly, the quality of life was improved significantly, 3 cases failed, including 1 case of cardiac perforation, 1 case of acute left heart failure caused by valvular tear, 1 case of termination of acute cerebral infarction during operation. Conclusion: 1.PBMV has the advantages of small trauma, quick recovery, safe and easy to be accepted by patients. 2.PBMV can effectively enlarge the area of mitral valve orifice, reduce pulmonary artery pressure and left atrial pressure, reduce the diameter of left atrium, and improve the clinical symptoms of patients. Improve the quality of life of patients. 3. The decrease of brain natriuretic peptide (BNP), hypersensitive C- reactive protein (hs-CRP) and endothelin-1 (ET-1) after PBMV may be related to the enlargement of mitral valve area and the decrease of left atrial pressure which can effectively improve hemodynamics.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.2
本文编号：2284915
[Abstract]:Objective: to investigate the clinical effect of percutaneous balloon mitral valvuloplasty (Percutaneous Ballon Mitral Valvuloplasty, PBMV) in the treatment of rheumatic mitral stenosis. The dynamic changes and significance of brain natriuretic peptide (BNP), hypersensitive C-reactive protein (hs-CRP) and endothelin-1 (ET-1) before and after PBMV. Methods: Thirty-nine patients with rheumatic mitral stenosis underwent percutaneous transluminal mitral valvuloplasty (PBMV) in our department. 14 male and 25 female patients with mean age of 48 卤11.6 years were selected. The mitral valve area (MVA), left atrial diameter (LAD), left atrial pressure (LAP) and pulmonary artery pressure (PAP).) were measured by color Doppler echocardiography 10 days, 30 days and 60 days after operation. The left atrial pressure (LAP) and pulmonary artery pressure (PAP).) were measured before and after PBMV. The concentrations of BNP,Hs-CRP and ET-1 in plasma were measured by peripheral venous blood samples at the corresponding time points. Results: (1) in 39 cases of PBMV, 36 cases were successful, and the success rate was 92.3%. 36 cases were treated with PBMV successfully. Immediately after PBMV, the mitral valve area (MVA) was significantly larger than that before PBMV, 10 days, 30 days, 60 days after PBMV. There was no significant difference in the area of mitral valve orifice (P0.05) immediately after). PBMV, there was no significant difference in left atrial diameter (LAD), but (LAD) gradually decreased at 10, 30 and 60 days after operation. There were significant differences in pulmonary artery pressure (PAP) and left atrial mean pressure (LAP) between before and after PBMV (P0.01). PBMV). The plasma BNP concentration decreased gradually 10 days after PBMV, 30 days after operation and 60 days after operation (P0.01). There was no significant difference in plasma hs-CRP concentration between 10 days after operation and 10 days after operation (P0.05). After 10 days, 30 days after operation, 60 days after operation, the plasma hs-CRP concentration gradually decreased, there was a significant difference (P0.01). There was no significant difference in plasma ET-1 concentration between 10 days after operation and 10 days after operation (P0.05). After 10 days, 30 days after operation, 60 days after operation, the plasma ET-1 concentration gradually decreased, there was significant difference (P0.01). The postoperative clinical symptoms were improved rapidly, the quality of life was improved significantly, 3 cases failed, including 1 case of cardiac perforation, 1 case of acute left heart failure caused by valvular tear, 1 case of termination of acute cerebral infarction during operation. Conclusion: 1.PBMV has the advantages of small trauma, quick recovery, safe and easy to be accepted by patients. 2.PBMV can effectively enlarge the area of mitral valve orifice, reduce pulmonary artery pressure and left atrial pressure, reduce the diameter of left atrium, and improve the clinical symptoms of patients. Improve the quality of life of patients. 3. The decrease of brain natriuretic peptide (BNP), hypersensitive C- reactive protein (hs-CRP) and endothelin-1 (ET-1) after PBMV may be related to the enlargement of mitral valve area and the decrease of left atrial pressure which can effectively improve hemodynamics.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.2
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