二尖瓣置换术后两种类型机械瓣对血流动力学的影响

 目的 评价不同类型机械瓣对二尖瓣置换术后血流动力学的影响.方法 本院行二尖瓣置换术96例,分为双叶瓣及倾斜碟瓣两组,比较手术前后及手术1年后两组间血流动力学的超声参数.结果 两组术前二维超声参数:各房室内径及主、肺动脉内径、二尖瓣口面积差异均无统计学意义,血流动力学参数中E峰、A峰、平均跨瓣压差(mean pressure gradient,MPG)、肺动脉收缩压差异均无统计学意义;术后10 d内的二维超声参数比较:双叶瓣及倾斜碟瓣两组的E峰速分别为(1.43±0.70)m/s和(1.86±0.65)m/s (P<0.05),有效瓣口面积(effective orifice area,EOA)分别为(2.61±0.61)cm2、(2.31±0.63)cm2(P<0.05);肺动脉收缩压(pulmonary artery systolic pressure,PASP)分别为(33.9±14.2)mmHg 和(32.8±9.4)mmHg(1 mmHg=0.133 kPa,P>0.05);MPG分别为(4.76±2.8)mmHg和(5.2±3.7)mmHg(P>0.05).手术1年后复查,双叶瓣及倾斜碟瓣两组的E峰速分别为(1.48±0.9)m/s和(1.92±0.4)m/s(P<0.05),EOA为(2.52±0.32)cm2和(2.01±0.2)cm2 (P<0.05),PASP为(33.4±22.5)mmHg 和(36.4±24.7)mmHg(P>0.05).结论 双叶机械瓣对风湿性心脏病二尖瓣置换术后血流动力学的影响强于倾斜碟瓣.

Hemodynamic effect of different mechanical valves in patients of rheumatic heart disease with a replaced mitral valve

Objective To assess the hemodynamic effect of different types of mechanical valves on patients with rheumatic heart disease （RHD） who received replacement of a mitral valve. Methods Ninety - six patients receiving replacement of the mitral valve were retrospectively analysed. They were divided into bileaflet valve group （ group 1 ） and tilting disk valve group （ group 2）. He- modynamic changes in the two groups were compared. Results The hemodynamic indices were not significantly different in the two groups before operation. Ten days after operation, the peak Evelocity in group 1 was significantly lower than that in group 2, （ 1.43 ± 0.70） m/s vs（1.86 ±0.65）m/s, （P〈0.05） ; the effective orifice area（EOA） was （2.61±0.61） cm^2 in group 1 vs （2.31 ±0. 63 ） cm^2 in group 2 （ P 〈 0.05 ）. One year after operation, the peak E velocity in group 1 was significantly lower than that in group 2, [ （ 1.48 ± 0.9） m/s vs （ 1.92 ± 0.4） mm, P 〈 0.05 ] , and the effective orifice area （EOA） was （2.52 ± 0.32） cm^2 in group 1 vs （ 2.01 ± 0.2 ） cm^2 in group 2 （ P 〈 0.05 ） Conclusions The bileaflet valve has a better dynamic influence than the tilting disk valve in patients of RHD with a replaced mitral valve.