经皮二尖瓣球囊扩张术对血浆内皮素及其内分泌的影响(摘要)

经皮二尖瓣球囊扩张术对血浆内皮素及其内分泌的影响（摘要）谢培怡⒇采用放射免疫法测定风湿性心脏病二尖瓣狭窄患者经皮二尖瓣球囊扩张术（ＰＢＭＶ）术前、术后血浆内皮素（ｅｎｄｏｔｈｅｌｉｎ，ＥＴ）、肾素、血管紧张素Ⅱ、心钠素的变化。并与心功能以及血流动力学...     

经皮球囊二尖瓣成形术后房颤患者ANP和BNP水平变化研究

目的探讨房颤患者行经皮球囊二尖瓣成形术（PBMV）后心房利钠肽（ANP）和脑钠肽（BNP）变化及与血流动力学参数的关系。方法选择因风湿性二尖瓣狭窄伴持续性房颤成功行PBMV患者38例,术前、术后1d及半年分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值,由超声心动图测左房内径（LAD）、二尖瓣口面积（MVA）、二尖瓣跨瓣压差（MPG）及肺动脉压（PAP）。结果PBMV术后患者血流动力学参数明显改善;术后1d及半年ANP水平较术前明显下降,BNP变化不明显。术后半年与术前比较,LAD与ANP下降相关（r=0．774,P〈0．05）,△BNP与△MPG相关（r=0．574,P〈0．05）。结论房颤患者PBMV术后半年血中ANP逐步下降,BNP降低不明显。房颤律时△ANP和△BNP仍是反映LAD和MPG变化的有效指标。     

经皮二尖瓣狭窄球囊扩张术后心功能的超声评价

目的探讨经皮二尖瓣球囊扩张术（PBMV）治疗非单纯性二尖瓣狭窄（MS）的效果。方法使用超声心动图检测65例单纯性MS，MS合并轻、中度二尖瓣关闭不全（MR）和MS合并轻、中度主动脉瓣关闭不全（AR），3组患者PBMV术前及术后复查时，左室射血分数（LVEF）值和心脏房、室内径大小变化。结果3组PBMV后复查LVEF值较术前明显增大（P〈0．01）；左室内径与术前比较差异有统计学意义（P〈0．05）；单纯性MS组和MS合并轻、中度AR组PBMV术后复查时左房内径比术前明显减小（P〈0．05）；MS合并轻、中度MR组PBMV术后左房内径与术前比较差异无统计学意义（P〉0．05）。结论非单纯性MS患者PBMV术后心功能有明显好转。     

二尖瓣球囊扩张术对患者血浆B型利钠肽水平的影响

目的:观察二尖瓣球囊扩张术(PBMV)对二尖瓣狭窄患者血浆B型利钠肽(BNP)水平的影响。方法:检测30例成功施行PBMV的二尖瓣狭窄患者(窦性心律21例,心房颤动9例)术前、术后20 min及术后24 h的血浆BNP浓度,与8例对照者比较,并将BNP浓度与血流动力学参数作相关分析。结果:术前30例二尖瓣狭窄患者血浆BNP水平显著高于对照者(P<0．01);且与平均左心房压(r=0．441,P< 0．05)和肺动脉压(r=0．488,P<0．01)呈正相关。心房颤动患者与窦性心律患者BNP浓度无明显差异。术后20 mim及术后24 h窦性心律患者BNP浓度较术前显著下降(P均<0．05),术后24 h左心室舒张末容量(P<0．01)和每搏输出量(P<0．05)较术前相应增加,左心室舒张末压不变;术后20 min的BNP浓度变化与平均左心房压变化(r=0．696,P <0．01)及肺动脉压变化(r=0．456,P<0．05)呈正相关。术后心房颤动患者BNP浓度较术前无明显改变,左心室舒张末容量和每搏输出量相应不变,左心室舒张末压术后20 min较术前增加(P<0．01)。结论:二尖瓣狭窄患者血浆BNP浓度升高和左心房压及肺动脉压升高相关。心脏节律对球囊扩张术后血浆BNP的变化起重要作用,BNP是反映窦性心律患者球囊扩张术后左心房压及肺动脉压变化的敏感指标,但这一指标不适用于心房颤动患者。     

介入治疗对冠心病患者血浆偶联因子6的影响及其机制分析

目的探讨介入治疗对冠心病患者血浆偶联因子6（CF6）的影响及其可能的机制。方法将冠心病患者根据临床情况进行配对，分为单纯冠脉造影组（对照组）和冠脉造影加介入治疗组（试验组），分别取手术当13及术后次日空腹肘静脉血，用放免法检测血浆CF6的含量。结果试验组术前CF6水平为（203．13±61．99）pg／ml，术后为（243．57±36．97）pg／ml，儿较术前明显升高（P〈0．01），且CF6浓度变化与手术持续时间（r=0．435，P〈0．05）、球囊扩张总时间（r=0．617，P〈0．01）、球囊扩张总次数（r=0．575，P〈0．01）、置入支架数目（r=0．674，P〈0．01）及术中心电图ST段改变（r=0．567，P〈0．01）等呈正相关。对照组手术前CF6水平为（192．90±52．68）pg／ml，术后为（201．06±63．33）pg／ml，无明显变化（P〉0．05）。结论介入治疗可能造成冠状动脉机械损伤、心肌缺血再灌注损伤、边支受累或慢血流状态而导致心肌缺血损伤，以及血流动力学改变而导致的切应力改变等情况，这些情况均可使得CF6表达和释放增加。     

血流会聚法与心导管法评价二尖瓣球囊扩张术疗效的对照研究

应用彩色多普勒血流会聚（FCR）法对21例风湿性二尖瓣狭窄患者于二尖瓣球囊扩张（PBMV）术前及术后测量二尖瓣口面积（MVOA）及心脏指数（CI），并与心导管（Cath）法所测MVOA及CI分别进行比较，发现两种方法间没有显著性差异（P＞0．05）。术后FCR法所测MVOA及CI均明显大于术前（P＜0．001）。上述结果表明无论术前还是术后FCR法测量MVOA和CI可行、可信，因而可较准确地评估PBMV的疗效，有广泛的临床应用价值。     

经皮球囊二尖瓣成形术治疗二尖瓣狭窄前后心钠素的改变

采用经皮球囊二尖瓣成形术治疗风湿性二尖瓣狭窄３８例，术前术后进行血浆心钠素浓度测定。结果显示，风湿性二尖瓣狭窄患者血浆心钠素浓度明显升高，术后随着狭窄瓣膜的扩张，左房压下降，血浆心钠素浓度明显下降，统计学处理有显著差异。因此认为血浆心钠素浓度测定是判断二尖瓣成形术效果和随访的一项可靠指标。     

二尖瓣狭窄球囊扩张术时血浆内皮素浓度快速增高

１７０二尖瓣狭窄球囊扩张术时血浆内皮素浓度快速增高［英］ＫｉｎｏｓｈｉｔａＯ…ＢｒＨｅａｒｔＪ．１９９３，６９．３２２～３２６本研究目的旨在进一步探讨二尖瓣狭窄患者经皮二尖瓣球囊扩张术前后血浆中内皮素浓度与血液动力学变化的关系。２５例患者（男７例、女...     

长球囊血管成形术联合长支架置入术治疗糖尿病下肢缺血患者的疗效

目的：比较长球囊血管成形术联合长支架置入术long balloon percutaneous transluminal angioplasty plus long stent implantation, LBPTALS）与普通球囊血管成形术联合普通支架置入术（ordinary balloon percutaneous transluminal angioplasty plus ordinary stent implantation, OBPTAOS）对血管内皮分泌功能的影响。方法：选择经下肢血管造影证实为股浅动脉狭窄单支病变的糖尿病下肢缺血患者43例，随机分为两组，分别接受LBPTALS，OBPTAOS术。术前、术后即刻、术后2h、术后7d分别抽取患肢静脉血样，以硝酸还原酶法比色测定血清一氧化氮（N0）浓度和一氧化氮合酶（NOS）活力，非平衡法放射免疫测定血浆内皮素（ET-1）浓度。结果：两组患者靶病变情况差异无统计学意义。LBPTALS组的手术时间、夹层数、置入支架数明显低于OBPTAOS组（P〈0．05）。LBPTALS组的球囊扩张次数明显少于OBPTAOS组（P〈0．01），LBPTALS组术后即刻、术后2h、术后7d的血清NO浓度、NOS活力高于OBPTAOS组（P〈0．05），血浆ET-1浓度低于OBPTAOS组（P〈0．05）。术后7d血清NO浓度、NOS活力开始恢复，但仍低于术前（P〈0．05）。术后7d血浆ET-1浓度开始恢复，但仍高于术前（P〈0．05）。结论：LBPTALS对糖尿病下肢缺血患者血清NO浓度、NOS活力、血浆ET-1浓度的影响，即对血管内皮功能减退的影响小于0BPTAOS，可能是前者减少内皮损伤所致。     

分级次二尖瓣球囊扩张术治疗重度二尖瓣狭窄伴心房颤动的临床研究

为评价分级扩张法行经皮穿刺二尖球囊扩张术（PBMV）的临床疗效。采用分级次扩张法对52例风湿性二尖瓣狭窄（MS）患者进行,分重度MS伴心房颤动（AF）组和中，重度MS无AF组。根据身高2确定首次扩张直径，每次递量0.5-1mm，直至疗效满意。术前，术后进行二维超声和多普勒，血流动力学检查。结果显示，52例PBMV均获成功，术后血流动力学明显改善，心功能明显提高，无重要并发症发生，两组间比较无明显差异。提示分级次扩张法可有效预防二尖瓣反流，低心排，急性左心衰，栓塞等并发症，并获得良好效果，尤其对重度MS伴AE者，不失为一种理想的治疗方法。     

经皮球囊二尖瓣成形术前后心功能的分析

作者采用心机图方法检测４５例二尖瓣狭窄患者行经皮球囊二尖瓣成形术前后的心功能变化。结果显示，术后收缩功能有显著改善；舒张功能亦有所进步，但除了全舒张时间及快速充盈波相对振幅比值有显著性差异外，其他指标虽有改善，但均无统计学意义。     

经皮腔内球囊二尖瓣成形术对二尖瓣狭窄患者肺功能的影响

目的 :观察单纯二尖瓣狭窄 (MS)患者接受经皮腔内球囊二尖瓣成形术 (PTBMV)治疗前后的肺功能指标的变化。方法 :PTBMV前 3天、术后 1周及 3个月进行定量肺呼吸功能测定 ,并与 10 0例健康体检者 (对照组 )比较。结果 :1MS组各项肺呼吸功能指标均低于对照组 (均 P <0 .0 1) ;2 PTBMV能显著改善上述指标(均 P <0 .0 1) ;3MS组肺呼吸功能指标与心脏血流动力学状态密切相关 (r =0 .5 0～ 0 .82 )。结论 :PTBMV对MS患者肺功能有显著改善作用。表明 PTBMV也是一项能有效改善 MS患者肺功能状态的治疗方法。这一结论进一步拓展了对 PTBMV治疗价值的认识。     

Comparison between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis. A prospective and randomized study

Eighty patients with tight and pliable mitral stenosis were randomized in a prospective trial comparing percutaneous balloon valvuloplasty and open commissurotomy. Mitral valve area increased significantly in both groups immediately after the procedures. However, a decrease in mitral valve area occurred in both groups at 6, 12 and 24 months during the follow-up. There was no death in either group. Two patients had significant mitral regurgitation after percutaneous balloon valvuloplasty. After 24 months, all patients in the commissurotomy group and 97.4% of the patients in the balloon valvuloplasty group were in New York Heart Association functional class I or II.     

Hemodynamic effects and long-term outcome of percutaneous balloon valvuloplasty in patients with mitral stenosis and atrial fibrillation

BACKGROUND: The presence of atrial fibrillation (AF) has been identified as a predictor of a suboptimal result in some patients undergoing percutaneous balloon valvuloplasty in the treatment of symptomatic rheumatic mitral stenosis. HYPOTHESIS: Atrial fibrillation adversely affects the short- and long-term outcome of patients with mitral stenosis undergoing percutaneous balloon valvuloplasty. METHODS: A retrospective chart review of 104 consecutive patients with rheumatic mitral stenosis undergoing percutaneous balloon valvuloplasty was performed. A successful procedure was defined as a final mitral valve area > or = 1.5 cm2 and the absence of a complication. Endpoints included freedom from mitral valve replacement, death, and repeat balloon valvuloplasty at 5 years. RESULTS: A successful procedure was obtained in 89% of patients with sinus rhythm and in 78% of patients with AF (p = NS). Patients in sinus rhythm had a greater cardiac output resulting in a larger final valve area than patients in AF (1.8 vs. 1.6 cm2, p < 0.05). Freedom from valve replacement, death, and repeat balloon valvuloplasty at 5 years was 75% for patients in AF and 76% for patients in sinus rhythm (p = NS). Lower postprocedure mitral regurgitation grade and absence of prior commissurotomy were the only independent predictors of event-free survival. CONCLUSIONS: Patients with mitral stenosis and AF have lower cardiac outputs and gradients than patients with sinus rhythm, despite similar valve areas. The long-term outcome of balloon valvuloplasty is independent of the initial cardiac rhythm.     

分级次二尖瓣球囊扩张预防二尖瓣反流的初步研究

目的为探讨经皮穿刺球囊导管二尖瓣扩张术（ＰＢＭＶ）引起二尖瓣反流（ＭＲ）的原因及其预防方法。方法我们采用分级次扩张法和改良Ｉｎｏｎｅ法对人体病变二尖瓣和硅胶二尖瓣模型进行体外球囊导管扩张实验，并对１３２例风湿性心脏病重度二尖瓣狭窄患者，其中分别以分级次扩张法９６例，Ｉｎｏｎｅ法３６例进行ＰＢＭＶ的前瞻性对比研究。结果（１）ＰＢＭＶ引起二尖瓣反流的原因除与瓣膜钙化程度重、瓣下结构紊乱有关以外，瓣口面积小、交界粘连处夹角小是一个重要原因。（２）分级次扩张可使交界粘合处夹角呈渐进性扩大，扩张时不易引起瓣膜撕裂和二尖瓣反流。两组比较Ｉｎｏｎｅ法扩张组二尖瓣反流发生率为１６．７％，分级次扩张组无二尖瓣反流病例，并且术中其他并发症及术后再狭窄发生率后者也明显低于前者。结论球囊导管分级次扩张可有效地预防二尖瓣反流，是治疗二尖瓣狭窄较理想的方法。     

Percutaneous balloon valvuloplasty for concurrent mitral, aortic and tricuspid rheumatic stenosis

Percutaneous balloon valvuloplasty has been used with good resultsto treat rheumatic mitral stenosis. However, its use in degenerativeaortic stenosis has shown many limitations. There is littleinformation about balloon valvuloplasty in tricuspid and aorticrheumatic stenosis. This article describes two patients withcombined rheumatic mitral, aortic and tricuspid stenosis inwhich triple percutaneous valvuloplasty was performed in a singleprocedure.     

Percutaneous balloon mitral valvuloplasty in comparison with open mitral valve commissurotomy for mitral stenosis during pregnancy.

OBJECTIVES: We sought to compare the maternal and fetal outcomes of patients with severe mitral stenosis submitted to percutaneous balloon dilation versus open mitral valve commissurotomy (MVC) during pregnancy. BACKGROUND: Heart failure in patients with mitral stenosis complicating pregnancy is a common problem in developing countries. Since 1984, percutaneous dilation of the mitral valve using a balloon catheter has become a therapeutic alternative to open heart surgery. Although the efficacy of percutaneous mitral valve balloon dilation is well established, its results have never before been compared with the results of commissurotomy during pregnancy. METHODS: We compared the clinical and obstetric complications in 45 women who were treated with percutaneous mitral valve balloon dilation (group I, n = 21; from 1990 to 1995) or open MVC (group II, n = 24; from 1985 to 1990) for severe heart failure due to mitral stenosis during pregnancy. RESULTS: In our study, percutaneous balloon dilation of the mitral valve had a success rate of 95% (Gorlin formula) and 90.5% (echocardiographic "pressure half-time" method), as demonstrated by the final mitral valve area achieved. This improvement was followed by a marked decrease in the mitral valve gradient, left atrial pressure and mean pulmonary artery pressure. Patients in both groups had similar improvements in symptoms. Patients who underwent percutaneous balloon dilation had significantly fewer fetal complications, with a reduction in fetal and neonatal mortality (1 death in group I vs. 8 in group II, p = 0.025). CONCLUSIONS: Percutaneous balloon mitral valvuloplasty is safe and effective and appears to be preferable for the fetus, compared with open MVC during pregnancy.     

老年二尖瓣狭窄患者经皮球囊二尖瓣成形术的探讨

目的探讨老年二尖瓣狭窄患者接受经皮球囊二尖瓣成形术(PBMV)的疗效和安全性。方法观察同期行PBMV的65例(年龄≥60岁)老年二尖瓣狭窄患者(老年组)和516例青壮年二尖瓣狭窄患者(青壮年组)的疗效和安全性。结果老年二尖瓣狭窄患者与青壮年二尖瓣狭窄患者接受PBMV的疗效和安全性相当;老年患者PBMV后二尖瓣再狭窄发生率显著低于青壮年(P<0.05)。结论老年二尖瓣狭窄患者和青壮年二尖瓣狭窄患者一样接受PBMV治疗安全、有效,且不易发生二尖瓣再狭窄。