老年患者二尖瓣狭窄球囊成形术并发症的防治

Prevention of complication of percutaneous balloon mitral valvuloplasty in elderly patients with mitral stenosis

目的 降低老年患者二尖瓣球囊成形术的并发症。方法 对 5 7例老年二尖瓣狭窄患者进行经皮二尖瓣球囊成形术 (PBMV)。将患者分为 :A组 2 7例 ,男性 11例 ,女性 16例 ,年龄 6 0～ 72 (6 6± 5 )岁 ,采用传统的PBMV技术 ;B组 30例 ,男性 10例 ,女性 2 0例 ,年龄 6 0～ 70 (6 4± 5 )岁 ,采用改进的PBMV技术 ,主要包括 :4种方法监控定位行房间隔穿刺 ;根据左心房大小调整二尖瓣导向探条前段的J形弧度 ;3种方法监控球囊导管是否已进入左心室并判断其未卡在腱索内 ;微级递增球囊直径扩张二尖瓣口等。结果 A组并发症为 2 6 % (7/ 2 7) ,其中中～重度二尖瓣关闭不全 4例 ,缓慢性心律失常及低血压 2例 ,心包填塞 1例 ;B组仅 3% (1/ 30 )发生中度二尖瓣关闭不全 ,两组比较 ,差异有显著性意义 (P <0 .0 5 )。超声心动图显示左心房内云雾状改变不是PBMV的禁忌证。

Objective To study the prevention of complication by improved percutaneous balloon mitral valvuloplasty(PBMV)in elderly patients with mitral stenosis.Methods Twenty seven patients with mean age of 66( 60～72)years underwent classical PBMV (group A).Thirty patients with mean age of 64( 60～70) years received improved PBMV(group B) which mainly included:atrial septal puncture monitored by four methods,adjusting J shaped arc of the guiding bougie depending on the size of left atria,judging whether balloon catheter has entered left ventricle by three methods,and mini gradual balloon mitral valvuloplasty.Results The rate of the complication after improved PBMV was significantly lower in group B than in group A (P< 0.05).Conclusion Improved PBMV is feasible and results in significant decrease in the complication in elderly patients.