發(fā)布時間：2018-05-28 14:58

  本文選題：超聲心動描記術 + 壓力　； 參考：《中國循環(huán)雜志》2017年04期

【摘要】：目的:探討小劑量多巴酚丁胺負荷超聲心動圖(LDDSE)檢查在主動脈瓣狹窄伴左心室功能不全、低流速低壓差患者行經皮主動脈瓣置換術(TAVR)的應用價值和安全性。方法:2013-10至2016-07,在我院連續(xù)入選列為常規(guī)外科換瓣手術禁忌,且準備行TAVR適應證評估的重度主動脈瓣狹窄患者,同時合并嚴重左心室功能不全伴低流速低壓差者,共納入有效病例5例。記錄LDDSE檢查前、過程中的平均跨瓣壓差、最大流速、每搏輸出量、射血分數,對判定為真性重度主動脈瓣狹窄且具有左心收縮儲備功能患者行TAVR治療,無左心收縮儲備功能者采取藥物治療或酌情行TAVR治療。觀察TAVR治療后心功能和N末端B型利鈉肽原(NT-pro BNP)變化。結果:5例患者均表現(xiàn)為LDDSE檢查陽性,平均跨瓣壓差均≥40mm Hg(1mm Hg=0.133k Pa),每搏輸出量增加≥20%,提示患者為真性重度主動脈瓣狹窄且有心臟收縮儲備功能。LDDSE過程中、結束后無明顯不良反應。其中4例行經TAVR治療,1例因暫無瓣膜等待TAVR或球囊擴張術。TAVR術后患者心功能逐漸好轉或恢復至正常,NT-pro BNP持續(xù)下降。結論:低流速低壓差且伴左心功能不全的重度主動脈瓣狹窄患者,可考慮行LDDSE檢查明確心功能儲備情況和主動脈瓣狹窄程度;如有心臟收縮功能儲備,建議行TAVR治療。TAVR是此類患者的有效治療手段。
[Abstract]:Objective: to evaluate the value and safety of low dose dobutamine stress echocardiography (LDDSEs) in the diagnosis of aortic stenosis with left ventricular insufficiency and low flow and low pressure difference in patients undergoing percutaneous aortic valve replacement (TAVR). Methods from 2013-10 to 2016-07, the patients with severe aortic valve stenosis who were selected as contraindication of conventional surgical valve replacement surgery and who were ready to be evaluated by TAVR were included in our hospital, and the patients with severe left ventricular insufficiency with low flow and low pressure, were included in the study. Five effective cases were included. The mean transvalve pressure difference, maximum flow velocity, stroke output, ejection fraction were recorded before LDDSE examination. Patients with severe aortic stenosis and left ventricular systolic reserve function were treated with TAVR. Patients without left ventricular systolic reserve were treated with drugs or TAVR as appropriate. To observe the changes of cardiac function and N terminal B type natriuretic peptide (NT-pro) after TAVR treatment. Results all of the 5 patients were positive for LDDSE, the mean cross-valve pressure difference was 鈮，

本文編號：1947157