CHANGES OF PLASMA BETA-ENDORPHIN LEVELS BEFORE AND AFTER PERCUTANEOUS TRANSVENOUS MITRAL COMMISSUROTOMY IN PATIENTS WITH MITRAL STENOSIS

To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta endorphin levels and hemodynamic changes in 35 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, plasma beta-endorphin levels obtained from the antecubital vein (28.91 ± 5.59 pg / ml) and from the femoral vein (28.20 ± 5.44 pg / ml) in the patients with mitral stenosis were significantly higher than those obtained from the antecubital vein in the healthy volunteers (22.59 ± 3.86 pg / ml, n = 34, P< 0.001 for each). The levels of beta-endorphin in the femoral vein correlated well with the mean left atrial pressure (r=0.777, P< 0.001) and the mean right atrial pressure (r = 0.450, P<0.01) before the procedure. The antecubital venous levels of beta-endorphin in patients in New York Heart Association functional Classess Ⅱ (26.45 ± 5.39 pg / ml, n = 20) and Ⅲ (32.20 ± 4.02 pg / ml, n = 15) were significantly higher than those in control subjects (P< 0.005 and P< 0.001, respectively). The differences between Classes Ⅱ and Ⅲ were significant (P < 0.001). The plasma levels of beta-endorphin in the patients complicated with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm (33.31 ± 3.22 pg / ml, n= 13 vs 26.32± 5.07 pg / ml, n = 22, P< 0.001). In ten to fifteen minutes after commissurotomy, plasma levels of beta-endorphin in the femoral vein significantly increased from 28.20 ± 5.44 to 33.14 ± 5.72 pg / ml (P< 0.001). In seventy-two hours after the procedure, plasma beta-endorphin levels in the antecubital vein fell to 24.37 ± 2.59 pg / ml (P< 0.001 vs before PTMC and P<0.05 vs control subjects). Plasma beta-endorphin levels in the patients with atrial fibrillation (26.62 ± 2.36 pg / ml, P< 0.001 vs before PTMC and P< 0.002 vs control subjects) were still higher (P< 0.001) than those in patients with normal shins rhythm (23.05 ± 1.65 pg / ml, P< 0.001 vs before PTMC and P>50 vs control subjects. There was a significant correlation between the levels of beta-endorphin in the antecubital vein and heart rate (r = 0.502, P< 0.001), mean transmitral pressure gradient (r = 0.543, P< 0.001) or mitral valve area (r = -0.710, P< 0.001) before and 72 hours after the procedure.

经皮二尖瓣球囊成形术后瓣口面积及血液动力学改变间相互关系研究

自１９９２年１１月至１９９４年６月，８２例风湿性二尖瓣狭窄（ＭＳ）患者在本院接受经皮二尖瓣球囊成形术（ＰＴＭＣ），其中男性２４例，女性５８例，平均年龄４０．７±９．６岁（２０～６２岁）。均于ＰＴＭＣ前后经超声心动图测二尖瓣口面积（ＭＶＡ）、跨二尖瓣压力阶差（ＭＰＧ），术中测肺动脉压力（ＰＡＰ）及左心房压力（ＬＡＰ）。结果：ＰＴＭＣ术后，ＭＶＡ显著增加（Ｐ＜０．００１），ＭＰＧ、ＰＡＰ及ＬＡＰ均显著降低（Ｐ＜０．００１）；ＭＶＡ平均增加１００％以上，ＰＡＰ和ＬＡＰ平均降低３０％～４０％，ＭＶＡ增加百分数（△ＭＶＡ）与ＰＡＲ（△ＰＡＰ）或／和ＬＡＰ降低百分数（△ＬＡＰ）间大致呈３：１比例，△ＬＡＰ与△ＭＶＡ有显著相关性，，ｒ＝０．２５，Ｐ＜０．０５；△ＰＡＰ与△ＬＡＰ间也有非常显著相关性，ｒ＝０．５２，Ｐ＜０．００１；由△ＬＡＰ可分别判断、推算△ＭＶＡ及△ＰＡＰ。结论：本研究提示，ＰＴＭＣ后ＬＡＰ降低百分数与ＭＶＡ增加百分数及ＰＡＰ降低百分数显著相关，由前者可推测后二者变化，可使ＰＴＭＣ效果的判断更简明，并建议将ＬＡＰ降低１／３作为ＰＴＭＣ成功的主要标志。本研究结果有明显临床实用价值，对国内基层医院开展此术更具?

经皮球囊扩张术治疗27例二尖瓣再狭窄效果研究

目的：探讨经皮球囊扩张术治疗二尖瓣再狭窄的临床效果。方法：对１９例闭式扩张术后二尖瓣再狭窄（ＭＲＳ）和经皮二尖瓣球囊扩张术（ＰＴＭＣ）后ＭＲＳ患者再次施行ＰＴＭＣ。结果：两组二尖瓣口面积（ＭＶＡ）分别增加７１％和７８％。闭式扩张术后经再次ＰＴＭＣ，ＭＶＡ从（１．３５±０．３４）ｃｍ２提高到（２．３１±０．３２）ｃｍ２，左房压（ＬＡＰ）由（２．３１±１．１０）ｋＰａ降到（１．２７±０．８７）ｋＰａ，二尖瓣跨瓣压差（ＭＰＧ），从（１．６４±０．６１）ｋＰａ降到（０．６２±０．３９）ｋＰａ。ＰＴＭＣ后ＭＲＳ组，再次ＰＴＭＣ：ＭＶＡ从（１．２５±０．２４）ｃｍ２提高到（２．２３±０．４２）ｃｍ２，ＬＡＰ由（３．３０±０．６１）ｋＰａ降到（１．２６±０．３６）ｋＰａ，ＭＰＧ由（１．８４±０．７３）ｋＰａ降到（０．５９±０．２０）ｋＰａ。结论：再次ＰＴＭＣ与首次ＰＴＭＣ效果相同。

经皮二尖瓣球囊成形术的近期疗效观察

目的：观察经皮二尖瓣球囊成形术（ＰＴＭＣ）的近期疗效。方法：对比分析８例中、重度风湿性二尖瓣狭窄（ＭＳ）ＰＴＭＣ术前、术后的临床资料。结果：ＰＴＭＣ术后心功能明显改善，舒张期杂音明显减弱或消失，右房内径由术前（４８．９±５．７）ｍｍ缩小至术后的（３８．５±９．６）ｍｍ（Ｐ〈０．０５），二尖瓣口面积由术前的（０．９３±０．０３）ｃｍ２增加至术后的（１．９２±０．０３）ｃｍ２（Ｐ＜０．０１），左房平均压由术前的（１９．８±６． ９）ｍｍＨｇ下降至（９．４±２．１）ｍｍＨｇ（Ｐ＜０．０１），左空射血分数由术前的（０．５３±０．０１）提高至术后的（０．６４±０．０１）（Ｐ＜０．０５）。结论： ＰＴＭＣ近期疗效明显且安全、可靠、恢复快，是行之有效的治疗ＭＳ的方法。