目的探讨风湿性二尖瓣狭窄合并肺动脉高压患者行二尖瓣置换术临床疗效. 方法选择52 例风湿性二尖瓣狭窄合并肺动脉高压患者,根据心脏彩超估测患者的肺动脉收缩压（SPAP）结果将患者分为3 组（轻度组、中度组、重度组）,所有患者均由同一医师进行二尖瓣置换术. 结果轻度组患者NYHA 分级Ⅰ,Ⅱ级比例显著高于中度组和重度组,重度组NYHA 分级Ⅲ,Ⅳ级比例显著高于轻度组和中度组（P〈0. 05）;治疗后,3 组患者SPAP 均较治疗前显著改善（P〈0. 05）,3 组患者手术后右心室内径较术前显著降低（P〈0. 05）,术后3 组患者心功能指标和6MWT 均显著改善;轻度组并发症发生率为30. 77%,重度组并发症发生率为83. 33%. 结论二尖瓣置换术能够显著改善风湿性二尖瓣狭窄合并肺动脉高压患者肺动脉负担,提高患者的心功能.
Objective To investigate the clinical efficacy of mitral valve replacement in patients with rheumatic mitral stenosis and pulmonary hypertension. Method A total of 52 patients with rheumatic mitral stenosis and pulmonary hypertension were selected. Pulmonary systolic pressure （ SPAP ） was estimated by preoperative echocardiography. According to the measurement results,the patients were divided into three groups,mild group, moderate group and severe group. All patients underwent mitral valve replacement by the same physician. The clinical data of the three groups were statistically analyzed. Using echocardiography and 6 min walk test on cardiac function in patients, the severity was assessed by Doppler ultrasound detector at 72 h before and after surgery,the patients＆#39; left and right ventricular function,LVEDV,RVEF and CVP were measured. Results The proportion of NYHA grade I and II in mild group was significantly higher than that in moderate group and severe group. The proportion of grade NYHA and grade IV in severe group was significantly higher than that in mild group and moderate group （P〈0. 05）. After treatment,SPAP in the three groups was significantly improved compared with that before treatment （ P〈0 . 05 ） . The right ventricular diameter in the three groups after the surgery was significantly lower than that before the surgery （P〈0. 05）. After surgery,both cardiac function indexes and 6 MWT in the three groups were significantly improved （ P〈0 . 05 ） . There was 1 case of pulmonary infection,1 cases of postoperative low cardiac output syndrome,and no death in the mild group,in 1 case died in the moderate group,with a complication rate of 30. 77%,a complication rate in the severe group is 83. 33%. Conclusion Mitral valve replacement can significantly improve the pulmonary artery burden of patients with rheumatic mitral stenosis and pulmonary hypertension,and improve the heart function of the patients.
Journal of Beihua University（Natural Science）
rheumatic mitral stenosis
mitral valve replacement