PTMC球囊直径的选择倾向性及其对即时扩张效果的影响

PTMC balloon diameter selection and its effect on the immediate expansion

目的分析球囊直径的选择倾向性及其对于即时扩张效果的影响。方法对1584例病历资料完整的接受经皮球囊二尖瓣扩张术(PTMC)的患者按照选择的最大球囊直径分为直径较大、中间和较小3组(L组、M组和S组),比较各组的基线资料和即时扩张效果。结果在3组中L组患者年龄较轻、左房平均压较高且二尖瓣口面积较大(P<0.01)。3组患者PTMC扩张后左房平均压分别下降(10.77±7.27)mmHg、(7.89±6.23)mmHg和(8.07±6.16)mmHg(P<0.01),3组患者PTMC扩张后二尖瓣口面积分别增加(1.09±0.54)cm2、(0.54±0.45)cm2和(0.50±0.37)cm(2P<0.01),3组患者PTMC后合并中度以上二尖瓣反流分别为24例(4.4%)、29例(5.0%)和18例(3.3%)(P>0.05)。结论 PTMC时,术者对年轻、左房平均压较高以及瓣膜病变较轻的患者倾向于选择较大球囊直径,而较大的球囊直径可以获得更好的扩张效果,而不增加二尖瓣反流几率。

【Objective】 To investigate the preference of selecting balloon diameter and its impact on instantaneous expansion effect.【Method】 1 584 patients with relatively complete medical records of percutaneous transvenous mitral commissurotomy（PTMC） were divided into 3 groups according to the largest balloon diameter： larger diameter group（group L）,middle diameter group（group M） and smaller diameter group（group S）,and then baseline information and immediate expansion results of each group were compared.【Results】 L group of patients were younger and had higher left atrial pressure and larger mitral valve area of 3 groups（P 0.01）.Average left atrial pressure of 3 groups decreased（10.77±7.27） mmHg,（7.89 ± 6.23） mmHg and（8.07± 6.16） mmHg respectively after PTMC expansion（P 0.01） with mitral valve area respectively increasing（1.09 ± 0.54） cm2,（0.54 ± 0.45） cm2 and（0.50 ± 0.37） cm2,（P 0.01）.24 cases（4.4%）,29 cases（5.0%） and 18 cases（3.3%） in each group were complicated with mitral regurgitation more than moderate grade after PTMC（P 0.05）.【Conclusion】 Patients who were younger or had higher left atrial pressure or whose valve disease is not serious were inclined to be chosen larger diameter balloon by operators,and a larger diameter balloon expansion can result in better effect,without increasing the mitral chance of reflux.