目的：分析风湿性二尖瓣狭窄患者二尖瓣置换术后的早期临床转归。方法：回顾分析128例因风湿性二尖瓣狭窄行二尖瓣置换术患者的临床资料,根据心脏彩超估测的肺动脉收缩压（SPAP）结果分为A组（30 mm Hg≤SPAP〈50 mm Hg,n=70）和B组（SPAP≥50 mm Hg,n=58）,比较2组一般资料、手术相关资料、围手术期结果及早期随访结果。结果：2组间除SPAP、肺功能及右心室内径外,其余术前指标差异均无统计学意义。围手术期死亡5例,A组2例,B组3例。术后机械通气时间及ICU治疗时间B组均大于A组（P均〈0.05）。术后2组患者SPAP均较术前下降（P均〈0.05）。术后6个月复查心脏彩超显示2组病例人工瓣膜功能良好;A组SPAP升高至术前水平或以上患者2例,B组11例,2组相比,差异有统计学意义（χ2=7.644,P=0.006）。结论：二尖瓣狭窄患者的术前肺动脉压高增加了术后复发肺动脉高压的风险,早期临床转归也相对较差。
Aim： To analyze early outcome of mitral valve replacement in rheumatic mitral stenosis patients with pulmonary artery hypertension. Methods： A retrospective analysis of 128 rheumatic mitral stenosis patients with pulmonary artery hypertension received mitral valve replacement was performed. They were allocated into 2 groups according to SPAP：group A（ 30 mm Hg≤SPAP 50 mm Hg,n = 70） and group B（ SPAP≥50 mm Hg,n = 58）. The general information,perioperative and postoperative data as well as the follow-up data were collected. Results： There were no significant differences in preoperative data except SPAP,pulmonary function or RVID between the 2 groups. In-hospital mortality was 5 in total,2 in group A and 3 in group B. The prolonged mechanical ventilation time and stay in ICU in group B were significantly longer than those in group A（ P 0. 05）. The SPAP declined after surgery in both groups. At 6 months after operation,the prosthetic valves all worked well; there were 2 patients＇ SPAP rising back to the level before surgery in group A and 11 in group B,and there was significant difference（ χ2= 7. 644,P = 0. 006）. Conclusion： The higher level of SPAP may increase the risk of SPAP rising after surgery,and result in worse early outcome.
Journal of Zhengzhou University： Med Sci
rheumatic heart disease
pulmonary artery hypertension
mitral valve replacement