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目的报道经皮球囊二尖瓣成形术(PBMV)治疗846例风湿性二尖瓣狭窄(MS)患者的疗效与体会。方法通过对接受PBMV治疗的846例MS患者资料进行回顾性分析,比较PBMV前后心脏杂音、NYHA心功能级别、二尖瓣返流(MR)程度、血动力学资料及二尖瓣口面积(MVA)的变化。结果846例中的843例完成了PBMV治疗。PBMV后,平均肺动脉压从(58±26)mm Hg(1mm Hg=0.133kPa)下降至(32±14)mm Hg(P<0.001)、平均左心房压由(42±11)mm Hg下降至(13±5)mmHg(P<0.001)、平均二尖瓣跨瓣压差(MVG)由(32±8)mm Hg下降至(9±4)mm Hg(P<0.001);MVA(n=768)由(0.96±0.32)cm2增加至(1.99±0.42)cm2(P<0.001);心排量从(4.3±1.2)L/min增加至(5.5±1.5)L/min(P<0.05),心指数从2.7±1.6增加至3.6±1.9(P<0.005),左心室射血分数由(47.9±10.2)%上升至(66.2±8.9)%(P<0.01)。PBMV后,826例(98%)症状显著改善,绝大多数患者的心杂音消失或减轻、NYHA心功能级别显著改善。重要并发症包括:急性心包填塞9例、Ⅰ~Ⅱ度MR 10例、原有Ⅰ~Ⅱ度MR程度不同地加重者9例、脑血栓栓塞1例、感染性休克1例。结论PBMV治疗MS是安全有效的;采用球囊直径递增法扩张并监测MVG、监听心杂音变化能有效预防严重MR的发生;正确的房间隔穿刺技术是预防心包填塞的关键。
Objective To report the efficacy and experience of percutaneous balloon mitral valvuloplasty (PBMV) in 846 patients with rheumatic mitral stenosis (MS). Methods The data of 846 patients with MS treated with PBMV were retrospectively analyzed. The heart murmur, NYHA function, mitral regurgitation (MR), hemodynamic data and MVA )The change. Results 843 out of 846 patients completed PBMV treatment. Mean PBP decreased from (42 ± 11) mm Hg to (32 ± 14) mm Hg (P <0.001) after PBMV from (58 ± 26) mm Hg The MVM decreased from (32 ± 8) mmHg to (9 ± 4) mmHg (P <0.001), MVA (n = 768) increased from (0.96 ± 0.32) cm2 to (1.99 ± 0.42) cm2 (P <0.001), and the cardiac output increased from 4.3 ± 1.2 L / min to 5.5 ± 1.5 L / min (P <0.05) , Heart index increased from 2.7 ± 1.6 to 3.6 ± 1.9 (P <0.005), left ventricular ejection fraction increased from (47.9 ± 10.2)% to (66.2 ± 8.9)% (P <0.01). After PBMV, the symptoms of 826 patients (98%) were significantly improved. The heart murmur disappeared or was reduced in the majority of patients, and the NYHA functional level was significantly improved. The major complications included: 9 cases of acute cardiac tamponade, 10 cases of grade Ⅰ ~ Ⅱ MR, 9 cases of exacerbation of grade Ⅰ ~ Ⅱ MR, 1 case of cerebral thromboembolism and 1 case of septic shock. Conclusions PBMV is safe and effective in the treatment of MS. The balloon diameter increment method is used to expand and monitor the MVG. Monitoring heart murmur can effectively prevent the occurrence of severe MR. Correct atrial septal puncture is the key to prevent pericardial stuffing.