二尖瓣球囊扩张术前后血皮质醇、胰岛素浓度及血流动力学的变化及意义

目的：探讨风湿性心脏病二尖瓣狭窄患者在行经皮二尖瓣球囊扩张术前后血皮质醇、胰岛素及血流动力学的变化及意义。方法：对于256例风湿性心脏病二尖瓣狭窄患者，在行经皮二尖瓣球囊扩张术前、后动态监测血皮质醇、胰岛素以及血流动力学参数的变化。结果：二尖瓣球囊扩张术术后第1d血皮质醇浓度比手术前非常显著升高（P〈0．01），术后第3d血皮质醇浓度较手术前显著升高（P〈0．05）；术后第1d血清胰岛素浓度比手术前非常显著升高（P〈0．01）；但术后有严重并发症者血皮质醇和胰岛素与术前比较均无显著性差异（P〉0．05）；术后血流动力学参数心率（HR）、二尖瓣面积（MVA）、左心房内径（LAD）及平均二尖瓣阶差（mMPG）与术前比较均有显著性差异（P〈0．01）。结论：经皮二尖瓣球囊扩张术后血皮质醇和胰岛素浓度先升高后降低，但有严重并发症者术后改变不明显，术后监测血皮质醇和胰岛素浓度可作为早期发现有无并发症的指标之一。

Clinical significant and changes of plasma cortisone,insulin,hemodynamics after percutaneous balloon mitral valvuloplasty

Objective:To investigate clinical significant and changes of plasma cortisone,insulin,hemodynamics after percutaneous balloon mitral valvuloplasty.Methods:Content of plasma cortisone,insulin and change of hemodynamics after percutaneous balloon mitral valvuloplasty were detected in 256 patients with rheumatic mitral stenosis.Results:The levels of plasma and insulin cortisone significantly increased in patients after percutaneous balloon mitral valvuloplasty(P<0.05);But the levels of plasma cortisol and insulin were not significant differences after percutaneous balloon mitral valvuloplasty in patients with serious complications(P>0.05).Hemodynamic parameters(heart rate,left atrial dimension,mean mitral valve pressure gradient) significantly improved in patients after percutaneous balloon mitral valvuloplasty(P<0.01).Conclusion:Monitor plasma cortisol and insulin can help detect the mitral stenosis patients complicated with severe complications after percutaneous balloon mitral valvuloplasty.