本文選題：二尖瓣狹窄 + 二尖瓣關閉不全�。� 參考：《昆明醫(yī)科大學》2016年碩士論文

【摘要】：[目的]總結在我院行單純二尖瓣置換術(MVR)的58例二尖瓣狹窄(MS)或二尖瓣關閉不全(MI)患者術前、術后及遠期隨訪時左心室結構的相關超聲心動圖數據,比較MVR術后MS與MI患者左心室重構過程,并總結相關臨床治療經驗。[方法]選擇2002年8月-2015年8月在昆明醫(yī)科大學第二附屬醫(yī)院胸心外科住院行MVR術的54例二尖瓣疾病(MS或MI)患者作為研究對象。根據其主要病變分為二尖瓣狹窄組(A組)和二尖瓣關閉不全組(B組),分別收集患者術前1周、術后1-2周及術后隨訪時LVD、LVEF數據,采用配對樣本t檢驗比較患者術前、術后及遠期的左心室內徑和左心室射血分數。[結果]所有患者均順利手術并出院。二尖瓣狹窄組(A組)患者的術后近期LVD(42.76±5.50mm)與術前(43.63±5.55mm)相比無顯著變化(P0.05)；術后近期LVEF(62.19%±7.05%)與術前LVEF(61.58%±6.51%)相比無顯著差異(P0.05)。遠期隨訪數據顯示本組遠期LVD(47.47±3.31mm)較術前增加,遠期LVEF(66.22%±4.4%)較術前有顯著提高(P0.05)。二尖瓣關閉不全組(B組)患者術后LVD(51.29±7.56mm)與術前(58.21±9.09mm)相比顯著降低(P0.05),而術后LVEF(59.08%±7.42%)較術前(61.25%±8.37%)無顯著變化(P0.05)。遠期隨訪數據顯示本組LVD(47.25±5.05mm,P0.05))較術前有顯著減小,遠期隨訪LVEF(61.92%±3.75%,P0.05)與術前相比無顯著變化,但與術后近期LVEF相比較有顯著提高(P0.05)。[結論]1二尖瓣狹窄為主要病變的患者MVR術后近期左心室內徑和射血分數與術前保持同一水平。術后遠期左心室較術前增大,左室射血功能較術前明顯增強。2二尖瓣關閉不全為主要病變的患者MVR術后近期左心室內徑較術前減小,左室射血分數與術前保持同一水平。術后遠期左心室進一步減小,左室射血分數與術前保持同一水平但較術后近期有所提高。3二尖瓣狹窄為主要病變的患者MVR術后左心室重構在遠期較明顯,二尖瓣關閉不全為主要病變的患者MVR術后左心室構型即有明顯改變,且術后遠期其左心室有進一步重構的過程。
[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 鹵5.50mm between the patients with mitral stenosis (43.63 鹵5.55mm) and the patients with mitral stenosis (62.19% 鹵7.05mm), and there was no significant difference between the patients with postoperative LVEFV (61.58% 鹵6.51mm) and the patients with preoperative LVEFV (61.58% 鹵6.51mm). Long-term follow-up data showed that the long-term LVD(47.47 鹵3.31mm in this group was higher than that before operation, and the long-term LVEF was 66.22% 鹵4.4mm, which was significantly higher than that before operation (P 0.05). The postoperative LVD(51.29 鹵7.56 mm of mitral valve insufficiency group (LVD(51.29 鹵7.56 mm) was significantly lower than that of preoperation (58.21 鹵9.09 mm), but the postoperative LVEFV 59.08% 鹵7.42%) had no significant change compared with that of preoperation (61.25% 鹵8.37 mm). Long-term follow-up data showed that the LVD(47.25 鹵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% 鹵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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R654.2

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