【摘要】 目的实时三维超声心动图评估功能性三尖瓣关闭不全患者三尖瓣成形前、后右室功能,为二尖瓣病变手术的同时实施三尖瓣成形提供依据。方法方便选取2016年1月—2017年6月该院胸外科住院患者中二尖瓣病变合并功能性三尖瓣反流患者88例(轻度反流20例、中度反流38例及重度反流30例)作为成形组,术中三尖瓣均行人工瓣环成形,随机选取20例心脏结构及功能正常者作为对照组,术前所有患者和对照组进行右室三维成像,术后6个月对所有患者施行右室三维成像,分析右室收缩功能,包括收缩末期容积(RVESV)、舒张末期容积(RVEDV)、每搏心输出量(SV)、射血分数(RVEF)。结果术前成形组轻度反流组与正常对照组比较无明显变化(P>0.01),术前成形组中度RVESV:(78.77±6.88)mL,RVEDV:(116.33±14.86)m L,SV:(60.57±12.11)mL,RVEF:(49.55±6.34)%及重度反流组RVESV:(83.50±10.66)mL,RVEDV:(132.75±13.11)mL,SV:(62.25±11.75)mL,RVEF:(40.34±5.71)%与轻度反流组(RVESV:(55.41±3.99)mL,RVEDV:(100.15±13.46)mL,SV:(56.83±7.71)mL,RVEF:(55.22±8.11)%比较均有明显变化(P<0.01),中度及重度反流组RVESV、RVEDV增大、SV下降、RVEF下降;轻度反流组各参数术前、术后比较差异无统计学意义(P>0.01);术后右室功能参数中度反流组ESV:(65.69±3.77)mL,EDV:(105.57±10.32)mL,SV:(60.68±8.72)m L,EF:(54.21±6.12)%及重度反流组ESV:(64.33±7.85)mL,EDV:(112.33±12.35)mL,SV:(70.13±9.38)mL,EF:(45.16±4.72)%与术前比较差异有统计学意义(P<0.01),RVESV及RVEDV减小、RVEF升高,右室功能比术前有好转,反流量减少。结论在治疗左心瓣膜病变同时,对功能性三尖瓣反流患者行成形术能有效改善右室功能和预后。实时三维超声心动图能准确评价功能性三尖瓣反流患者的右室功能,为正确的治疗提供可靠依据。更多还原

【Abstract】 Objective To evaluate the anterior and posterior right ventricular function of tricuspid valvuloplasty in patients with functional tricuspid regurgitation by real-time three-dimensional echocardiography, and to provide a basis for tricuspid valvuloplasty during mitral valve surgery. Methods From January 2016 to June 2017, 88 patients with mitral valve disease complicated with functional tricuspid regurgitation were convenient selected enrolled in the hospital(20 cases of mild reflux,38 cases of moderate reflux, and severe reaction flow in 30 cases) as the forming group, the intraoperative tricuspid valve was performed with artificial annulus. 20 patients with normal cardiac structure and function were randomly selected as the control group. All patients and control group underwent right ventricular three-dimensional imaging. Three-dimensional imaging of the right ventricle was performed in all patients, and right ventricular systolic function was analyzed, including end-systolic volume(RVESV), end-diastolic volume(RVEDV), cardiac output per stroke(SV), and ejection fraction(RVEF). Results There was no significant change in the mild reflux group between the preoperative group and the normal control group(P>0.01). The preoperative group was moderate RVESV:(78.77 ±6.88)mL, RVEDV:(116.33 ±14.86)mL, SV:(60.57±12.11)mL, RVEF:(49.55±6.34)% and severe reflux group RVESV:(83.50 ±10.66)mL, RVEDV:(132.75±13.11)mL, SV:(62.25±11.75)mL, RVEF:(40.34±5.71)% and mild reflux group RVESV:(55.41±3.99)mL, RVEDV:(100.15±13.46)mL, SV:(56.83±7.71)mL, RVEF:(55.22±8.11)%. There were significant changes(P<0.01). RVESV, RVEDV,SV decreased, RVEF decreased in moderate and severe reflux group; mild reflux. There were no statistically significant differences between the parameters of the group before and after operation(P>0.01). The right ventricular function parameters were moderately refluxed ESV:(65.69±3.77)mL, EDV:(105.57±10.32)mL SV:(60.68±8.72)mL, EF:(54.21±6.12)mL and severe reflux group ESV:(64.33±7.85)mL, EDV:(112.33±12.35)mL, SV:(70.13±9.38)mL, EF:(45.16±4.72)% were statistically significant compared with preoperative(P<0.01), RVESV And RVEDV decreased, RVEF increased, right ventricular function improved, and reverse flow decreased. Conclusion In the treatment of left valvular disease, anesthesia in patients with functional tricuspid regurgitation can effectively improve right ventricular function and prognosis. Real-time three-dimensional echocardiography can accurately evaluate the right ventricular function of patients with functional tricuspid regurgitation and provide a reliable basis for correct treatment.更多还原