【摘要】：目的：探討經(jīng)皮二尖瓣狹窄球囊成形術(shù)(Percutaneous Ballon Mitral Valvuloplasty, PBMV)治療風(fēng)濕性二尖瓣狹窄患者的臨床效果。PBMV前后的腦鈉肽(BNP)、超敏C-反應(yīng)蛋白(hs-CRP)及內(nèi)皮素-1(ET-1)的動態(tài)變化及意義。方法：選擇因風(fēng)濕性二尖瓣狹窄在我科行經(jīng)皮二尖瓣狹窄球囊成形術(shù)(PBMV)的住院患者39例,男性患者14人,女性患者25人,平均年齡為48±11.6歲,觀察術(shù)前,術(shù)后10天,30天,60天行彩色多普勒超聲測定二尖瓣瓣口面積(MVA)、左心房內(nèi)徑(LAD)等相關(guān)指標(biāo)。PBMV前后測左心房壓(LAP)及肺動脈壓(PAP)。在相應(yīng)的時間點抽取外周靜脈血測血漿的BNP、Hs-CRP及ET-1濃度。結(jié)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積(MVA)較術(shù)前明顯增大,術(shù)后10天,30天,60天,二尖瓣瓣口面積無顯著性差異(P0.05)。PBMV后即刻左心房內(nèi)徑(LAD)對比術(shù)前無顯著性差異,術(shù)后10天,30天,60天左心房內(nèi)徑(LAD)逐漸縮小,與PBMV前相比差異均有顯著性(P0.01)。PBMV后即刻肺動脈壓(PAP)及左房平均壓(LAP)較術(shù)前明顯下降。3,血漿中BNP濃度PBMV術(shù)后10天,術(shù)后30天,術(shù)后60天逐漸下降,與術(shù)前對比差異顯著(P0.01)。血漿中hs-CRP濃度PBMV術(shù)后10天與術(shù)前對比無顯著性差異(P0.05),術(shù)后10天,術(shù)后30天,術(shù)后60天,血漿中hs-CRP濃度逐漸下降,出現(xiàn)顯著性差異(P0.01)。血漿中ET-1濃度PBMV術(shù)后10天與術(shù)前對比無顯著性差異(P0.05),術(shù)后10天,術(shù)后30天,術(shù)后60天,血漿的ET-1濃度逐漸下降,出現(xiàn)顯著性差異(P0.01)；4,成功行PBMV的36例患者,術(shù)后臨床癥狀均迅速改善,患者生存質(zhì)量明顯提高。5,手術(shù)失敗3例,包括心臟穿孔終止手術(shù)1例,瓣膜撕裂致急性左心衰終止手術(shù)1例,術(shù)中發(fā)生急性腦梗塞終止手術(shù)1例。結(jié)論：1.PBMV創(chuàng)傷小,術(shù)后恢復(fù)快,安全,容易被病人接受。2.PBMV能有效的擴(kuò)大二尖瓣瓣口面積,降低肺動脈壓及左房壓,縮小左房內(nèi)徑,能迅速改善患者臨床癥狀,提高患者的生存質(zhì)量。3. PBMV術(shù)后生物學(xué)標(biāo)記物腦鈉肽(BNP)、超敏C-反應(yīng)蛋白(hs-CRP)及內(nèi)皮素-1(ET-1)等指標(biāo)的下降可能與二尖瓣瓣口面積擴(kuò)大,左心房壓力下降,有效改善血流動力學(xué)有關(guān)。
[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 鹵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.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.2

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