经皮球囊二尖瓣成形术治疗风湿性心脏病二尖瓣狭窄对P波离散度的影响

目的 探讨经皮球囊二尖瓣成形术(PBMV)治疗风湿性心脏病二尖瓣狭窄对P波离散度的影响.方法选择风湿性心脏病二尖瓣狭窄并成功行PBMV术患者.术前窦性心律,术后维持窦性心律6个月以上,共95例,男21例,女74例,年龄18～57岁(37.5±7.9岁).所有患者均测量PBMV前、后12导联同步心电图P波宽度,计算最宽P波(P_(max))、最窄P波(P_(min))并取两者差的平均值,即为P波离散度(Pd),Pd=P_(max)-P_(min)(最大P波宽度-最小P波宽度);所有患者均测量PBMV前、后心电图Ⅱ导联P波高度;所有患者均测量PBMV前、后心电图V_1导联测得的心房终东电压(Ptf-V_1).结果 PBMV术前、术后患者,年龄、心率、左室舒张期内径、右室舒张期内径和左室射血分数(EF)无统计学差异.PBMV术后左房内径(41.86±5.46mm)比术前(44.48±5.60mm)显著缩小(P<0.01);术后P_(max)(113.33±14.92ms)比术前P_(max)(116.85±15.68ms)显著缩小(P<0.01);术后Pd(29.05±14.56ms)比术前Pd(32.83±12.87ms)显著缩小(P<0.05);术后P波高(0.14±0.05mV)比术前(0.18±0.07mV)显著缩小(P<0.01);术后Ptf-V_1(-0.020±0.019mm·s)比术前(-0.037±0.033mm·s)显著缩小(P<0.01).结论PBMV对心房间的传导的时间及振幅有明显作用,应用这些无创性电生理指标对判定PBMV的预后可能会有一

The Influence of Percutaneous Balloon Mitral Valvuoplasty on P Wave Dispersion in Patients with Rheumatic Mi- tral Stenosis

objective To investigate the changes of P-wave dispersion before and after percutaneous balloon mitral valvuoplasty (PBMV). Methods 95 cases of rheumatic mitral stenosis and sinus rhythm before and after 6 months PBMV who had undergone percutaneous balloon mitral valvuoplasty were selected. The maximum P-wave duration (Pmax), minimum P-wave duration (Pmin) and difference between the maximum and minimum P-wave duration (P-wave dispersion, Pd) from the 12-lead surface electrocardiogram were measured before and after the procedure. The P-wave height from the Ⅱ -lead surface of electrocardiogram and P terminal force from the V1-lead (Pt-fV1) surface electrocardiogram were measured before and after the procedure. Results There were no significant differences in the respect of age, heart rate, left ventricular dimension, right ventricular dimension and left ventricular ejection fraction by echocardiography before and after PBMV. Left atrial dimension was found to be significantly shorten after PBMV than before (41. 86±5. 46mm vs 44. 48±5. 60mm, P<0. 05 ). Pmax and Pd was found to be significantly shorten after PBMV (113. 33±14. 92ms 116. 85±15. 68ms vs, P<0. 01, 29. 05±14. 56ms vs 32. 83±12. 87ms,P<0. 05). Episode P-wave height and PtfV1 was also found to be significantly shorten after PBMV (0. 14±0. 05mV vs.0. 18±0. 07mV, P<0. 01, -0. 020±0. 019mm. s vs -0. 037±0. 033, P<0. 01). Conclusion The transmition time and swing among the artria have evidence action by PBMV. The simple electrocar-diographic markers that could be used for the prediction of PBMV