發(fā)布時(shí)間：2018-05-28 14:58

  本文選題：超聲心動(dòng)描記術(shù) + 壓力　； 參考：《中國(guó)循環(huán)雜志》2017年04期

【摘要】：目的:探討小劑量多巴酚丁胺負(fù)荷超聲心動(dòng)圖(LDDSE)檢查在主動(dòng)脈瓣狹窄伴左心室功能不全、低流速低壓差患者行經(jīng)皮主動(dòng)脈瓣置換術(shù)(TAVR)的應(yīng)用價(jià)值和安全性。方法:2013-10至2016-07,在我院連續(xù)入選列為常規(guī)外科換瓣手術(shù)禁忌,且準(zhǔn)備行TAVR適應(yīng)證評(píng)估的重度主動(dòng)脈瓣狹窄患者,同時(shí)合并嚴(yán)重左心室功能不全伴低流速低壓差者,共納入有效病例5例。記錄LDDSE檢查前、過(guò)程中的平均跨瓣壓差、最大流速、每搏輸出量、射血分?jǐn)?shù),對(duì)判定為真性重度主動(dòng)脈瓣狹窄且具有左心收縮儲(chǔ)備功能患者行TAVR治療,無(wú)左心收縮儲(chǔ)備功能者采取藥物治療或酌情行TAVR治療。觀察TAVR治療后心功能和N末端B型利鈉肽原(NT-pro BNP)變化。結(jié)果:5例患者均表現(xiàn)為L(zhǎng)DDSE檢查陽(yáng)性,平均跨瓣壓差均≥40mm Hg(1mm Hg=0.133k Pa),每搏輸出量增加≥20%,提示患者為真性重度主動(dòng)脈瓣狹窄且有心臟收縮儲(chǔ)備功能。LDDSE過(guò)程中、結(jié)束后無(wú)明顯不良反應(yīng)。其中4例行經(jīng)TAVR治療,1例因暫無(wú)瓣膜等待TAVR或球囊擴(kuò)張術(shù)。TAVR術(shù)后患者心功能逐漸好轉(zhuǎn)或恢復(fù)至正常,NT-pro BNP持續(xù)下降。結(jié)論:低流速低壓差且伴左心功能不全的重度主動(dòng)脈瓣狹窄患者,可考慮行LDDSE檢查明確心功能儲(chǔ)備情況和主動(dòng)脈瓣狹窄程度;如有心臟收縮功能儲(chǔ)備,建議行TAVR治療。TAVR是此類患者的有效治療手段。
[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，

本文編號(hào)：1947157