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目的:研究PCI治疗缺血性二尖瓣返流患者的临床疗效。方法:入选2015年3月至2016年8月在第二军医大学附属长海医院心血管内科确诊为冠状动脉粥样硬化性心脏病并植入支架(不包括急诊PCI、风湿性心脏病、心梗病史)的患者100例,将其分为无返流、轻度返流及中重度返流三组,对行PCI患者的术前与术后三月复查心脏彩超结果进行对比。结果:三组之间LVEF差异明显(62.57±2.76%vs 60.47±6.75%vs 48.54±9.96,p<0.001);但各组之间的病变血管分布及支架植入个数比较差异并无明显统计学意义(P>0.05);PCI术后二尖瓣返流改善值为(-0.43±0.51 mL vs 0.58±1.65 mL vs 4.27±5.12 mL,p<0.001);LVEF变化值分别为(-0.13±3.05%vs 1.52±4.13%vs 6.23±6.87%,p<0.001)。中重度返流患者PCI血运重建后返流量相对于轻度返流和无返流的患者明显减少(4.27±5.12 mL vs 0.58±1.65 mL,p<0.001;4.27±5.12 mL vs-0.43±0.51 mL,p<0.001),轻度返流组术后二尖瓣返流及LVEF较无返流组无明显改变(p>0.05)。结论:LVEF和二尖瓣返流程度密切相关,而PCI对于重度缺血性二尖瓣返流疗效较好,但并未发现冠脉病变分布上及支架植入个数的差异。
Objective: To study the clinical efficacy of PCI in patients with ischemic mitral regurgitation. Methods: From March 2015 to August 2016, patients with coronary atherosclerotic heart disease and stent implantation (excluding emergency PCI, rheumatic heart disease, myocardial infarction History), 100 patients were divided into three groups: no regurgitation, mild regurgitation and moderate-to-severe regurgitation. The results of cardiac echocardiography were compared between preoperative and postoperative March in patients undergoing PCI. Results: There was significant difference in LVEF between the three groups (62.57 ± 2.76% vs 60.47 ± 6.75% vs 48.54 ± 9.96, p <0.001). However, there was no significant difference between the groups in the distribution of vascular lesions and the number of stents implanted (P0.05). The improvement of mitral regurgitation after PCI was (-0.43 ± 0.51 mL vs 0.58 ± 1.65 mL vs 4.27 ± 5.12 mL, p <0.001). The changes of LVEF were (-0.13 ± 3.05% vs 1.52 ± 4.13% vs 6.23 ± 6.87%, p <0.001). Patients with moderate-severe reflux had significantly less regurgitation after revascularization than those with mild regurgitation and no regurgitation (4.27 ± 5.12 mL vs 0.58 ± 1.65 mL, p <0.001; 4.27 ± 5.12 mL vs-0.43 ± 0.51 mL, p <0.001). There was no significant difference in mitral regurgitation and LVEF between mild reflux group and non-reflux group (p> 0.05). CONCLUSION: LVEF is closely related to the degree of mitral regurgitation, while PCI has a good effect on severe ischemic mitral regurgitation. However, there is no difference in the distribution of coronary lesions and the number of stent implants.