经皮球囊二尖瓣成形术前后三种计算二尖瓣口面积方法的比较

对３３例以二尖瓣狭窄为主的风湿性心脏病患者进行研究，比较了经皮球囊二尖瓣成形术（ＰＢＭＶ）前后３种计算二尖瓣瓣口面积的方法。统计表明，ＰＢＭＶ前Ｇｏｒｌｉｎ公式，多普勒超声心动图压差减半时间及二维超声心动图测量的二尖瓣口面积间有显著相关，但ＰＢＭＶ后仅二维超声心动图测量二尖瓣口面积（ＭＶＡＥ）与连续波多普勒超声心动图测量二尖瓣口面积（ＭＶＡＤ）维持ＰＢＭＶ前相似的相关性；３种方法计算的瓣口面积在ＰＢＭＶ前后的变化率亦不相关。ＰＢＭＶ后血液动力学改变对Ｇｏｒｌｉｎ公式及压差减半时间计算的二尖瓣口面积有明显影响，３种计算二尖瓣口面积的方法不能混用，ＰＢＭＶ术后测量二尖瓣口面积应以二维超声心动图方法为准。

COMPARISON OF THREE METHODS FOR CALCULATING MITRAL VALVE AREA BEFORE AND AFTER PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Three methods for calculating the mitral valve area were compared before and after percutaneous balloon mitral valvuloplasty(PBMV) in thirty-three patients with rheumatic mitral stenosis. The results showed that, before PBMV ,there were only fair correlations between mitral valve area derived form Gorlin's formula (MVA_G), from Doppler pressure half-time(MVA_D) and from tow-dimensional echocardiographic planimetry (MVA_E) (MVA_(DVS). MVA_E, r= 0. 565, p= 0. 001 ; MVA_(GVS). MVA_E, r=0. 49 , p= 0. 004 ; MVA_(DVS). MVA_G, r=0. 38, p= 0.031); and MVA_D was significantly less than MVA_E and MVA_G (both P<0.001), but there was no significant difference bet-ween MVA_G and MVA_E(p=0. 327 ). After PBMV , However , there was only fair correlation between MVA_D and MVA_E (r =0.568 ,p=0.002) ; both MVA_G and MVA_D were less than MVA_E significantly(both P<0.001) and MVA_D was also less than MVA_G significantly(p<0.001). Moreover, there were no correlations between the percentage of mitral valve area increasing calculated by the three methods(all p>0.05). We concluded that MVA_E should be selected to evaluate the PBMV effect and for long-term follow-up because MVA_G and MVA_D were both influenced by hemodynamic changes. (Department of Internal Medicine, Second Affiliated Hospital, He Bei Medical College ,Hebei,Shijiazhuang)