双瓣膜置换术中不同型号人工瓣膜匹配的左心血液流体力学分析

目的探讨双瓣膜置换术（DVR）中人工瓣膜的不同匹配对左心流体力学环境的影响。方法将120例双瓣膜置换术的患者，根据术中主动脉瓣与二尖瓣，人工瓣膜匹配情况分为匹配组（A组）（n=62）和不匹配组（B组）（n=58），通过术后心脏彩超，测量，计算并比较两组左房应力（LAS）、射血分数（EF）、短轴缩短率（FS）、每搏量（SV）和主动脉瓣最大跨瓣压差（Pmax）、平均跨瓣压差（Pmax）、最大跨瓣流速（Vmax）、平均跨瓣流速（Vmax）等流体力学指标。结果两组的LAS、EF、FS、SV和Pmax、Pmax等指标均无显著性差异（P〉0．05），B组最大跨瓣流速（Vmax）、平均跨瓣流速（Vmax）大于A组（P〈0．05）。结论双瓣膜置换术中人工机械瓣的选择，应当根据患者的体表面积和实测瓣口直径来决定主动脉瓣膜的型号，只要能满足最低心脏指数即可，二尖瓣则可根据实测大小进行选择，不必拘泥于机械的所谓匹配原则。

Objective To study the effects of different matching prosthetic valve on the hydrodynamics of left heart in double vavle replacement （DVR）. Methods According to matching with aortic vavle and Mitral vavle prosthesis, tweety patients were allocated into two groups ： match group （ A group） （ n = 62 ） and dismatch group （ B group） （ n = 58 ）, hydrodynamic index, such as atria sinistrum, ejection fraction, shorting fraction, stroke volume and aortic valva max straddle valve gradient pressure, average straddle valve gradient pressure, max straddle valve flow number, average straddle valve flow number were measured, calculated and compared. Result There is no significant difference between two group （P 〉 0. 05 ）. there is significant difference between two group in Vmax and V （ P 〈 0. 05 ）. Conclusion Election of artificial mechanical prosthetic valve in double vavle replacement （DVR） should be on the basis of body surface area and true measurement of valve orifice diameter, minimum cardiac index is enough,alternative of bicuspid valve should he based on practical measure. Matching principle is not necessary.