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目的:研究平均左心房压(LAMP)变化对经皮球囊二尖瓣扩张术(PBMV)预后的预测价值。方法:2001-01至2006-12在我院成功行PBMV患者167例,其中105例资料完整并完成2年随访,失访患者21例,资料不完整41例。手术采用改良的Inoue球囊法。导管测定患者PBMV术前、术后LAMP,计算左心房压变化,由临床医师对患者的心功能进行评价,并于术前及术后2年行6分钟步行试验(6MWT)。应用超声心动图测定患者术前及术后2年二尖瓣瓣口面积(MVA),二尖瓣跨瓣压差(MVG)、左心室射血分数(LVEF)、左心房内径(LAD)等参数。随访时间为2年。将术后2年6分钟步行试验与术后一周6分钟步行试验对比,心脏原因导致的死亡、二尖瓣置换术、重复PBMV、心力衰竭等设为评价预后的指标。将105例患者分为预后好组(n=66)和预后差组(n=39)。结果:①预后好组与预后差组比较Wilkins评分、术后即刻二尖瓣反流程度、术前及术后2年LAMP、术前二尖瓣瓣口面积、术后2年左心房内径、术前及术后2年6分钟步行试验、术后2年肺动脉压两组间差异具有统计学意义(P<0.05～0.001)。②多元Iogistic回归分析LAMP变化、术后肺动脉压程度及术后二尖瓣反流程度纳入回归方程。结论:LAMP变化、术后肺动脉压程度及术后二尖瓣反流程度为PBMV术后预测预后的预测因素。
Objective: To study the predictive value of the change of mean left atrial pressure (LAMP) on the prognosis of percutaneous balloon mitral valvuloplasty (PBMV). Methods: From January 2001 to December 2006, 167 patients with PBMV were successfully treated in our hospital. Among them, 105 cases were complete and completed 2 years of follow-up. There were 21 cases of missing patients and 41 cases of incomplete data. Surgery using a modified Inoue balloon method. The catheter was used to measure the preoperative and postoperative LAMP in patients with PBMV. The change of left atrial pressure was calculated. The cardiac function of the patients was evaluated by the clinician. The 6MWT (6MWT) was performed preoperatively and 2 years after the operation. Echocardiography was used to measure mitral valve area (MVA), MVG, LVEF and LAD before and 2 years after operation parameter. Follow-up time was 2 years. The 2-year, 2-year, 6-minute walk test was compared with the 6-minute walk test one week after surgery. Cardiac death, mitral valve replacement, repeat PBMV, and heart failure were all used as indexes to evaluate prognosis. 105 patients were divided into good prognosis group (n = 66) and poor prognosis group (n = 39). Results ①The Wilkins score, the degree of postoperative immediate mitral regurgitation, preoperative and postoperative 2-year LAMP, preoperative mitral valve area, 2-year left atrial diameter, Preoperative and postoperative 2 years and 6 minutes walk test, pulmonary arterial pressure 2 years after the difference was statistically significant (P <0.05 ~ 0.001). ② multivariate Iogistic regression analysis of LAMP changes, postoperative pulmonary arterial pressure and postoperative degree of mitral regurgitation into the regression equation. CONCLUSION: The changes of LAMP, the degree of postoperative pulmonary arterial pressure and the degree of postoperative mitral regurgitation are predictors of postoperative prognosis of PBMV.