本文選題：風(fēng)濕性二尖瓣狹窄　切入點(diǎn)：保留瓣下結(jié)構(gòu)　出處：《福建醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的通過實(shí)時(shí)三維超聲心動(dòng)圖(Real-time three-dimensional echocardiography RT-3DE)檢測左心室心肌節(jié)段參數(shù),評估風(fēng)濕性二尖瓣狹窄患者術(shù)前左心室結(jié)構(gòu);評價(jià)保留瓣下結(jié)構(gòu)的二尖瓣置換術(shù)對風(fēng)濕性二尖瓣狹窄患者左心室心肌的影響。方法選取2014年10月-2014年12月福建省立醫(yī)院住院經(jīng)臨床體檢、實(shí)時(shí)三維超聲心動(dòng)圖檢查、術(shù)后病理明確診斷為風(fēng)濕性二尖瓣狹窄(Rheumatic mitral stenosis RMS)的患者25例(A組),以正常健康人20例作為對照組。25例RMS患者對二尖瓣狹窄的手術(shù)方式均采用保留瓣下結(jié)構(gòu)的二尖瓣置換術(shù)。此25例RMS患者術(shù)后為B組。記錄患者年齡、手術(shù)前后血壓、瓣口面積、術(shù)中主動(dòng)脈阻斷時(shí)間、總體外循環(huán)時(shí)間、術(shù)中出血量等。3組患者均采用美國GE Vivid E9超聲顯像儀進(jìn)行二維超聲心動(dòng)圖(Two-dimensional echocardiography 2DE)及實(shí)時(shí)三維超聲心動(dòng)圖(RT-3DE)檢查,記錄2DE的左室射血分?jǐn)?shù)(Left ventricular ejection fraction LVEF),左心室舒張末期容積(left ventricular end diastolic volume,LVEDV)、左心室收縮末期容積(left ventricular end systolic volume,LVESV)、RT-3DE的手術(shù)前后的LVEF、LVEDV、LVESV、左心室心肌各節(jié)段的縱向應(yīng)變值、圓周應(yīng)變值、面積應(yīng)變值、橫向應(yīng)變值。采用SPSS 19.0統(tǒng)計(jì)分析軟件分析,每組數(shù)據(jù)均用Shapiro-Wilk檢驗(yàn)是否符合正態(tài)性分布,如符合正態(tài)性分布則組間心功能及同步性參數(shù)比較采用兩獨(dú)立樣本t檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義,組內(nèi)心功能及術(shù)前、術(shù)后同步性參數(shù)比較采用配對樣本t檢驗(yàn)P0.05為差異有統(tǒng)計(jì)學(xué)意義。如不符合正態(tài)性分布則采用秩和檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果三組二維超聲的LVEF無明顯變化(P0.05);RT-3DE的LVEF、LVEDV、LVESV實(shí)驗(yàn)組(A、B)較對照組有明顯差異(P0.05);A組左心室心肌縱向應(yīng)變實(shí)驗(yàn)組較對照組大部分節(jié)段有明顯減小(P0.05),A組圓周應(yīng)變、面積應(yīng)變、橫向應(yīng)變與對照組無明顯差異(P0.05)。A組與B組左心室部分心肌節(jié)段(中間段下壁等)應(yīng)變有明顯差異(P0.05)。結(jié)論1、通過RT-3DE對風(fēng)濕性二尖瓣病人左心室心肌各節(jié)段的運(yùn)動(dòng)參數(shù)檢測,證明風(fēng)濕性二尖瓣狹窄患者術(shù)前既已出現(xiàn)左心室結(jié)構(gòu)變化。2、手術(shù)后,后組乳頭肌附著的左心室壁運(yùn)動(dòng)比其余左心室壁運(yùn)動(dòng)幅度增加。3、保留瓣下結(jié)構(gòu)的二尖瓣置換(mitral valve replacement with preservation of subvalvular apparatus,MVRP)術(shù)能夠較好的維持了左心室結(jié)構(gòu)的完整性,防止換瓣術(shù)后左心室的過度擴(kuò)張,大大降低了手術(shù)后并發(fā)癥的風(fēng)險(xiǎn)。
[Abstract]:Objective to evaluate the left ventricular structure in patients with rheumatic mitral stenosis by real-time real-time three-dimensional echocardiography RT-3DED.To evaluate the effect of mitral valve replacement with preservation of subvalvular structure on left ventricular myocardium in patients with rheumatic mitral stenosis.Methods from October 2014 to December 2014, Fujian Provincial Hospital was examined by clinical examination and real-time three-dimensional echocardiography.Twenty-five patients with rheumatic mitral stenosis (rheumatic mitral stenosis RMS) were treated with mitral valve replacement with preservation of subvalvular structure in group A and 20 healthy persons as control group. 25 patients with RMS underwent subvalvular mitral valve replacement.The 25 patients with RMS were treated as group B after operation.The patient's age, blood pressure before and after operation, valve area, aortic occlusion time, total cardiopulmonary bypass time were recorded.Two-dimensional echocardiography _ (2DE2) and real-time three-dimensional echocardiography (RT-3DEE) were performed with GE Vivid E9 echocardiography.Transverse strain value.Using SPSS 19.0 statistical analysis software, the data of each group were tested by Shapiro-Wilk to test whether the normal distribution was consistent with the normal distribution, if the normal distribution, the comparison of cardiac function and synchronicity parameters between groups using two independent samples t test (P0.05) had statistical significance.The heart function and postoperative synchrony parameters were compared by paired sample t test (P0.05).If the distribution was not consistent with normal distribution, the difference was statistically significant by rank sum test (P 0.05).Results there was no significant change in LVEF in the three groups of two-dimensional ultrasound. There was significant difference in the LVEFV V V V B of the LVEFV DVV LVESV group and the control group. Compared with the control group, the longitudinal strain of left ventricular myocardium in the P0.05A group significantly decreased the circumference strain and the area strain of the left ventricular myocardium in group A, compared with that in the control group.There was no significant difference between the transverse strain and the control group. There was significant difference between group A and group B in the strain of left ventricular segment (middle inferior wall, etc.).Conclusion: 1. By measuring the motion parameters of left ventricular myocardium in patients with rheumatic mitral valve by RT-3DE, it is proved that the changes of left ventricular structure have occurred in patients with rheumatic mitral stenosis before and after operation.In the posterior group, the left ventricular wall motion with papillary muscle attachment increased by .3.The mitral replacement valve replacement with preservation of subvalvular apparatus MVRP with retaining subvalvular structure could maintain the integrity of the left ventricular structure.Prevention of overexpansion of the left ventricle after valve replacement significantly reduces the risk of postoperative complications.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.2

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