经皮二尖瓣球囊成形术和血栓前状态

Percutaneous Balloon Mitral Valvuloplasty and Prethrombotic State

目的：探讨经皮二尖瓣球囊成形术（ＰＢＭＶ）前后血栓前状态与血液动力学的变化。 方法：对２０ 例有症状的风湿性心脏病二尖瓣狭窄患者根据其心律情况分为窦性心律组（ｎ＝ ８），和心房颤动心律组（ｎ＝ １２），并施行ＰＢＭＶ，观察ＰＢＭＶ前后血液流变学和血液动力学参数。同时选择２０名正常人作为正常对照（正常对照组）。 结果：在ＰＢＭＶ后血液动力学参数发生变化的同时纤维蛋白原（Ｆｂｇ）显著下降（Ｐ＜ ０．０１）。左心房血液成份在心房颤动心律组与窦性心律组之间有明显差异（Ｐ＜ ０．０５～０．０１），其中Ｄ－二聚体和全血粘度的低切变差异最显著（Ｐ＜０．０１）。 结论：风湿性心脏病二尖瓣狭窄患者存在血栓前状态基础和血液动力学异常，尤其是心房颤动者。

Objective:The aim of this study was to observe the changes of prethrombotic state and homedynamics before and after percutaneous balloon mitral valvuloplasty(PBMV). Method:PBMV were applied to 20 patients with rheumatic heart disease of mitral stenosis,who were divided into two groups,one is in sinus rate ( n =8),and the other is in atrial fibrillation ( n =12).Observation was made over the parameters of hemorrheology and homedynamics before and after BPMV.Twenty normal persons were selected as control group. Result:After PBMV,changes of homedynamics and of hemorrheology observed with fibrinogen (Fbg) reduced emarkably ( p <0 01).The left atrial blood component during atrial fibrillation is quite different from that during sinus rate ( p <0 05～0 01),with the difference of the fibrin D dimer(D D) and the low shear of blood viscosity in particular ( p <0 01). Conclusion:This shows the prethroumbotic state base and homedynamics of the patient with rheumatic mitral stenosis are abnormal.Such patients,especially those with atrial fibrillation,should accept of anticoagulant.