风湿性心脏病左心室心肌病理改变与术后心功能的关系

Relationship Between Rheumatic Pathological Changes of Left Ventricular Muscle and Postoperative Cardiac Function

目的：探讨风湿性心脏病左心室心肌病理改变与术后心功能的关系。 方法：将２０例风湿性心脏病二尖瓣置换患者，按术后有无低心排血量分为正常心排血量组（ｎ＝ １４）和低心排血量组（ｎ＝ ６）。另有８例男性健康意外脑死亡者为正常对照组。应用彩色病理图像分析系统，对其左心室后乳头肌基底部组织病理改变进行定量分析，并观察改变的程度与术后心功能的关系。 结果：风湿性左心室心肌内小动脉壁增厚管腔狭窄，血管内、外径比值约为正常对照组的３８％ ，肌间及血管周围纤维化明显增多，约为正常对照组的６倍，心内膜纤维组织增生变厚，约为正常对照组的４ 倍。其中，低心排血量组与正常心排血量组比较，心肌内小动脉内、外径比值（０．１０±０．０３ ｖｓ．０．１６±０．０３）降低，间质纤维化面积（２４．７０±２．９０％ ｖｓ．２０．３０±３．９０％ ）增大，心内膜厚度（１３０．２±１６．９ μｍ ｖｓ．９９．２±１１．１ μｍ ）增大（Ｐ均＜ ０．０５），而两组心肌细胞直径无显著差异。 结论：风湿性左心室心肌内小动脉壁增厚、管腔狭窄、间质纤维化面积、心内膜纤维组织增生，很可能是导致术后低心排血量的病理基础之一。

Objective:To explore the relation between rheumatic pathological changes of left ventricular muscle and postoperative cardiac function. Methods:The pathological changes of posterior papillary muscle of left ventricle in 20 patients underwent mitral valve replacement were measured by color pathmorphologic analysis system,and the extent of changes were compared with normal cardiac output group and low cardiac output group. Results:The rheumatic intramyocardial arteriolar inner and outer diameter ratio(Di/Do)was about 38% of controls,adventital and perivascular fibrosis area(F%)was about 6 fold of controls,endocardial thickness(ET)was about 4 fold of controls.In low cardiac output group( n =6) comparing with normal cardiac output group( n =14),Di/Do(0 10±0 03 vs.0 16±0 03),F%(24 7±2 9% vs.20 3±3 9%),and ET(130 2±16 9μm vs.99 2±11 1μm)changes were significantly severer(all P <0 05),but the cellular diameters were comparable. Conculsion:In rheumatic hearts,intramyocardial arteriolar wall thickening with obliteration of the lumen,adventitial and perivascular fibrosis,and endocardial fibrosis with thickening are probably the pathogenic basis of developing postoperative low cardiac output.