风湿性二尖瓣狭窄伴重度肺动脉高压及小左室患者围术期综合治疗效果分析

Clinical outcome of surgical treatment for patients with small left ventricle associated with mitral stenosis and pulmonary hypertension

目的 探讨风湿性二尖瓣狭窄伴重度肺动脉高压及小左室患者围术期综合治疗后的临床效果.方法 将风湿性二尖瓣狭窄伴重度肺动脉高压患者共计152例按照左室大小分为小左室组（67例）及非小左室组（85例）,比较两组患者围术期及随访后的临床指标.结果 ①入院时小左室组中心静脉压（CVP）明显高于非小左室组,右心室射血分数（RVEF）明显低于非小左室组,差异具有统计学意义（P＜0.05）,且小左室组肝功损伤程度较非小左室组严重.②小左室组治疗后肝功较入院时有所改善.两组患者术后CVP较入院时均显著降低,RVEF均明显上升（P＜0.05）,两组间无明显差异;手术对肺动脉高压的改善均非常明显.同时,术后雾化吸入“万他维”5d组,较未吸入组肺动脉收缩压（SPAP）明显降低（P＜0.05）.③远期随访发现,两组患者的SPAP均较入院显著改善（P＜0.05）;两组患者肝功、再住院率、血栓栓塞率、死亡率、6min步 行实验（6MWT）距离和心功能分级均无明显差异;小左室组左心室舒张末期容积指数（LVEDVI）相比入院时有显著升高（P＜0.05）,而且与非小左室组间已无明显差异.结论 风湿性二尖瓣狭窄伴重度肺动脉高压及小左室的患者术前状况较差,手术风险大,但经过围术期的合适处理,术后恢复好,与非小左室组患者无显著差异.

Objective To evaluate the clinical outcome of comprehensive treatment in preoperative period for patients with mitral stenosis associated with small left ventricle. Methods We analyzed the clinical data of 152 patients with mitral stenosis and pulmonary hypertension, all patients were divided into the small left ventricle group （67 cases） and the non-small left ventricle group （85 cases ）. The perioperative and follow-up clinical parameters of 2 groups were compared. Results （1）The CVP of the small left ventricle group was higher than the non-small left ventricle group when patients entering, in the same time, the RVEF was significantly worse than the non-small left ventricle group （P〈0.05）. The liver function was also worse than the non-small left ventricle group. （2）The liver function before surgery of the small left ventricle group was better compared with admission. The CVP and RVEF of the postoperative in both groups were better than entering, there were no significant difference between the two groups. The surgery can generate significantly lower the SPAP of both groups, while, ＂Ventavis＂ nebulizing inhaled got a better efficacy （P〈0.05）. （3）For the long-term effect, the SPAP of beth groups decreased distinctly, there was a significant increase of the LVEDVI in small left ventricle group. The liver function, mortality, admission rate, thromboembolism, 6MWT and cardiac functional grading were no significant difference between the two groups. Conclusion Patients with small left ventricle associated with mitral stenosis and pulmonary hypertension had a poor condition when entering, there were more surgical risk. However, through the appropriate treatment during perioperative period, patients recovered well, and there were no significant difference between the two groups.