本文選題：風濕性二尖瓣狹窄　切入點：保留瓣下結構　出處：《福建醫(yī)科大學》2015年碩士論文

【摘要】：目的通過實時三維超聲心動圖(Real-time three-dimensional echocardiography RT-3DE)檢測左心室心肌節(jié)段參數(shù),評估風濕性二尖瓣狹窄患者術前左心室結構;評價保留瓣下結構的二尖瓣置換術對風濕性二尖瓣狹窄患者左心室心肌的影響。方法選取2014年10月-2014年12月福建省立醫(yī)院住院經(jīng)臨床體檢、實時三維超聲心動圖檢查、術后病理明確診斷為風濕性二尖瓣狹窄(Rheumatic mitral stenosis RMS)的患者25例(A組),以正常健康人20例作為對照組。25例RMS患者對二尖瓣狹窄的手術方式均采用保留瓣下結構的二尖瓣置換術。此25例RMS患者術后為B組。記錄患者年齡、手術前后血壓、瓣口面積、術中主動脈阻斷時間、總體外循環(huán)時間、術中出血量等。3組患者均采用美國GE Vivid E9超聲顯像儀進行二維超聲心動圖(Two-dimensional echocardiography 2DE)及實時三維超聲心動圖(RT-3DE)檢查,記錄2DE的左室射血分數(shù)(Left ventricular ejection fraction LVEF),左心室舒張末期容積(left ventricular end diastolic volume,LVEDV)、左心室收縮末期容積(left ventricular end systolic volume,LVESV)、RT-3DE的手術前后的LVEF、LVEDV、LVESV、左心室心肌各節(jié)段的縱向應變值、圓周應變值、面積應變值、橫向應變值。采用SPSS 19.0統(tǒng)計分析軟件分析,每組數(shù)據(jù)均用Shapiro-Wilk檢驗是否符合正態(tài)性分布,如符合正態(tài)性分布則組間心功能及同步性參數(shù)比較采用兩獨立樣本t檢驗,P0.05為差異有統(tǒng)計學意義,組內(nèi)心功能及術前、術后同步性參數(shù)比較采用配對樣本t檢驗P0.05為差異有統(tǒng)計學意義。如不符合正態(tài)性分布則采用秩和檢驗,P0.05為差異有統(tǒng)計學意義。結果三組二維超聲的LVEF無明顯變化(P0.05);RT-3DE的LVEF、LVEDV、LVESV實驗組(A、B)較對照組有明顯差異(P0.05);A組左心室心肌縱向應變實驗組較對照組大部分節(jié)段有明顯減小(P0.05),A組圓周應變、面積應變、橫向應變與對照組無明顯差異(P0.05)。A組與B組左心室部分心肌節(jié)段(中間段下壁等)應變有明顯差異(P0.05)。結論1、通過RT-3DE對風濕性二尖瓣病人左心室心肌各節(jié)段的運動參數(shù)檢測,證明風濕性二尖瓣狹窄患者術前既已出現(xiàn)左心室結構變化。2、手術后,后組乳頭肌附著的左心室壁運動比其余左心室壁運動幅度增加。3、保留瓣下結構的二尖瓣置換(mitral valve replacement with preservation of subvalvular apparatus,MVRP)術能夠較好的維持了左心室結構的完整性,防止換瓣術后左心室的過度擴張,大大降低了手術后并發(fā)癥的風險。
[Abstract]:Objective to evaluate the left ventricular structure in patients with rheumatic mitral stenosis by real-time real-time three-dimensional echocardiography RT-3DED.To evaluate the effect of mitral valve replacement with preservation of subvalvular structure on left ventricular myocardium in patients with rheumatic mitral stenosis.Methods from October 2014 to December 2014, Fujian Provincial Hospital was examined by clinical examination and real-time three-dimensional echocardiography.Twenty-five patients with rheumatic mitral stenosis (rheumatic mitral stenosis RMS) were treated with mitral valve replacement with preservation of subvalvular structure in group A and 20 healthy persons as control group. 25 patients with RMS underwent subvalvular mitral valve replacement.The 25 patients with RMS were treated as group B after operation.The patient's age, blood pressure before and after operation, valve area, aortic occlusion time, total cardiopulmonary bypass time were recorded.Two-dimensional echocardiography _ (2DE2) and real-time three-dimensional echocardiography (RT-3DEE) were performed with GE Vivid E9 echocardiography.Transverse strain value.Using SPSS 19.0 statistical analysis software, the data of each group were tested by Shapiro-Wilk to test whether the normal distribution was consistent with the normal distribution, if the normal distribution, the comparison of cardiac function and synchronicity parameters between groups using two independent samples t test (P0.05) had statistical significance.The heart function and postoperative synchrony parameters were compared by paired sample t test (P0.05).If the distribution was not consistent with normal distribution, the difference was statistically significant by rank sum test (P 0.05).Results there was no significant change in LVEF in the three groups of two-dimensional ultrasound. There was significant difference in the LVEFV V V V B of the LVEFV DVV LVESV group and the control group. Compared with the control group, the longitudinal strain of left ventricular myocardium in the P0.05A group significantly decreased the circumference strain and the area strain of the left ventricular myocardium in group A, compared with that in the control group.There was no significant difference between the transverse strain and the control group. There was significant difference between group A and group B in the strain of left ventricular segment (middle inferior wall, etc.).Conclusion: 1. By measuring the motion parameters of left ventricular myocardium in patients with rheumatic mitral valve by RT-3DE, it is proved that the changes of left ventricular structure have occurred in patients with rheumatic mitral stenosis before and after operation.In the posterior group, the left ventricular wall motion with papillary muscle attachment increased by .3.The mitral replacement valve replacement with preservation of subvalvular apparatus MVRP with retaining subvalvular structure could maintain the integrity of the left ventricular structure.Prevention of overexpansion of the left ventricle after valve replacement significantly reduces the risk of postoperative complications.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2

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