本文選題：二尖瓣狹窄　切入點(diǎn)：經(jīng)皮二尖瓣球囊擴(kuò)張　出處：《南昌大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討右室起搏下左房壓力(LAP)變化與經(jīng)皮球囊二尖瓣成形術(shù)(PBMV)的理想擴(kuò)張終點(diǎn)的關(guān)系,為準(zhǔn)確判斷PBMV擴(kuò)張終點(diǎn)、安全有效完成PBMV提供客觀依據(jù)。方法:將42例適宜行PBMV手術(shù)的風(fēng)濕性心臟病二尖瓣狹窄患者隨機(jī)分為2組:對(duì)照組、右室起搏組。對(duì)照組采用球囊直徑計(jì)算、心臟雜音聽診、球囊形態(tài)觀察及動(dòng)態(tài)觀察左房壓力變化確定PBMV是否到達(dá)擴(kuò)張終點(diǎn)。右室起搏指導(dǎo)組于術(shù)前常規(guī)行右室快速起搏,而后按對(duì)照組方法選擇擴(kuò)張終點(diǎn)并完成PBMV。記錄患者一般臨床資料、心臟超聲指標(biāo)、心功能指標(biāo),使用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)的統(tǒng)計(jì)學(xué)處理,通過組間比較和組內(nèi)比較的方法,分析2組患者在PBMV前后心臟超聲指標(biāo)和心功能指標(biāo)的改變,探討右室起搏下左房壓力變化與PBMV的理想擴(kuò)張終點(diǎn)的關(guān)系,為安全有效完成PBMV提供更多實(shí)驗(yàn)依據(jù)。結(jié)果:與PBMV術(shù)前比較,2組患者術(shù)后均出現(xiàn)左房平均壓力mLAP下降、二尖瓣瓣口面積MVA增大;術(shù)后一周6分鐘步行距離(6MWT)增加,左心房內(nèi)徑LAD縮小;心功能評(píng)級(jí)(NYHA)提升。2組患者術(shù)后二尖瓣口面積、左心房內(nèi)徑、左室舒張末壓力、二尖瓣跨瓣壓力差、左室射血分?jǐn)?shù)、6分鐘步行距離及NYHA心功能評(píng)分均具有統(tǒng)計(jì)學(xué)差異(P㩳0.05);2組術(shù)后二尖瓣返流無明顯差異。結(jié)論:PBMV術(shù)后,患者臨床癥狀緩解,血流動(dòng)力學(xué)異常明顯糾正,運(yùn)動(dòng)耐量顯著提升。其中,右室起搏組排除了不同心率及節(jié)律影響,擴(kuò)張終點(diǎn)選擇更為科學(xué)精準(zhǔn),擴(kuò)張后效果更佳。
[Abstract]:Objective: to investigate the relationship between the changes of left atrial pressure (LAP) under right ventricular pacing and the ideal end point of percutaneous balloon mitral valvuloplasty (PBMV). Methods: 42 patients with mitral stenosis of rheumatic heart disease who were suitable for PBMV operation were randomly divided into two groups: control group and right ventricular pacing group. Balloon morphology and dynamic observation of left atrial pressure to determine whether PBMV reached the end of dilation. Then the end point of dilation was selected according to the method of control group and PBMV. the general clinical data, cardiac ultrasound index, cardiac function index were recorded, and the data were processed by SPSS13.0 statistical software, and the data were compared between groups and within groups. To investigate the relationship between left atrial pressure under right ventricular pacing and the ideal end point of PBMV, the changes of echocardiography and cardiac function were analyzed before and after PBMV in two groups. Results: compared with PBMV, the mean left atrial pressure (mLAP) decreased, the mitral valve area (MVA) increased and the walking distance (6 MW) increased 6 minutes after operation. Left atrial diameter (LAD) was reduced, cardiac function rating was increased in group 2, mitral orifice area, left atrial diameter, left ventricular end-diastolic pressure, mitral valve cross-valve pressure were poor. Left ventricular ejection fraction (LVEF) and 6-minute walking distance and NYHA cardiac function score were significantly different (P < 0.05). There was no significant difference in mitral regurgitation between the two groups. Conclusion the clinical symptoms were alleviated, hemodynamic abnormalities were corrected, and exercise tolerance was significantly improved in the two groups. The right ventricular pacing group excluded the effects of different heart rate and rhythm. The choice of expansion end point is more scientific and accurate, and the effect after expansion is better.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張學(xué)洪;李華泰;;對(duì)經(jīng)皮球囊二尖瓣成形術(shù)的幾點(diǎn)認(rèn)識(shí)[J];中國介入心臟病學(xué)雜志;2015年09期

2 陳偉偉;高潤霖;劉力生;朱曼璐;王文;王擁軍;吳兆蘇;李惠君;鄭哲;蔣立新;胡盛壽;;《中國心血管病報(bào)告2014》概要[J];中國循環(huán)雜志;2015年07期

3 周裔忠;李華泰;盛國太;;結(jié)合國情客觀認(rèn)識(shí)歐美指南關(guān)于經(jīng)皮二尖瓣球囊成形術(shù)的建議[J];中國循環(huán)雜志;2015年02期

4 陸林祥;鄭從波;劉興龍;方雁;譚文亮;李文波;洪浪;李華泰;;經(jīng)皮二尖瓣球囊擴(kuò)張術(shù)治療風(fēng)濕性心臟病二尖瓣狹窄合并二尖瓣中重度關(guān)閉不全的療效[J];南昌大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2013年12期

5 周裔忠;盛國太;洪明;李華泰;;經(jīng)皮二尖瓣球囊成形術(shù)治療老年風(fēng)濕性二尖瓣狹窄130例[J];中國老年學(xué)雜志;2013年14期

6 陳建軍;周勝華;沈向前;;預(yù)防經(jīng)皮球囊二尖瓣成形術(shù)后二尖瓣反流的進(jìn)一步研究[J];現(xiàn)代生物醫(yī)學(xué)進(jìn)展;2010年17期

7 唐昱;盛國太;洪明;葛郁芝;李華泰;;二尖瓣球囊成形術(shù)在二尖瓣狹窄合并左房血栓形成中的應(yīng)用[J];臨床心血管病雜志;2010年01期

8 吳玉付;李醒三;;風(fēng)心病單純二尖瓣狹窄與合并心房顫動(dòng)患者左心房壓力變化的觀察[J];重慶醫(yī)學(xué);2010年01期

9 吳海;林松;文宏;黃偉強(qiáng);劉艷麗;朱立光;陶新智;;老年二尖瓣狹窄患者經(jīng)皮球囊二尖瓣成形術(shù)的探討[J];中華老年心腦血管病雜志;2006年08期

10 盛國太,李華泰,葛郁芝,洪明,錢何娟,洪浪;經(jīng)皮球囊左房室瓣狹窄擴(kuò)張術(shù)遠(yuǎn)期療效評(píng)價(jià)[J];介入放射學(xué)雜志;2005年S1期

，

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