【摘要】 目的研究和评价瓣膜成形环对功能性三尖瓣关闭不全的治疗效果。方法选取2015年10月至2016年4月在广东省人民医院应用瓣膜成形环治疗功能性三尖瓣关闭不全的111例患者,分别于术前及术后1周、3个月、1年进行经胸二维多普勒超声心动图检查,选取心尖部四腔心切面,测定并记录各阶段收缩期的三尖瓣反流面积(area of tricuspid regurgitation,STR)、右心房内径(right atrium diameter,DRA)、右心室内径(right ventricle inner diameter,DRV)、左心室射血分数(left ventricular ejection fraction,LVEF)及肺动脉压力(pulmonary artery pressure,PPA)的数据值。结果将111例患者的STR、DRA、DRV、LVEF、PPA共5个观察指标的数据值按检查时间的先后顺序分为术前、术后1周、术后3个月、术后1年共4组,将各组数据按照观察指标分别进行配对比较分析,除术后1周组与术后3个月组在STR上的比较及术前组与术后3个月组在LVEF上的比较差异无统计学意义(P> 0.05)外,其余各组之间配对比较的差异均有统计学意义(P <0.05)。相关性分析显示,STR与DRA之间、STR与PPA之间在手术前后均呈显著正相关;STR与DRV之间在术前无相关性,术后呈正相关;STR与LVEF之间在术前无相关性,术后呈负相关。术后所有患者的纽约心脏协会(NYHA)心功能分级均较术前明显提高。结论对功能性三尖瓣关闭不全患者应用瓣膜成形环治疗体现了良好的近中期治疗效果,可减少术后三尖瓣反流的复发率、维护右心房室内径、降低肺动脉压、改善左心功能,从而改善患者的预后,有临床推广价值和意义。更多还原

【Abstract】 ObjectivesTo study and evaluate the effect of annuloplasty ring in the treatment of functional tricuspid regurgitation.MethodsA total of 111 patients with functional tricuspid regurgitation who underwent tricuspid annuloplasty from October 2015 to April 2016 in Guangdong Provincial People′s Hospital were selected. The transthoracic echocardiography was performed at preoperation,1 week,3 months and 1 year postoperation. Apical four chamber view was selected. The data of area of tricuspid regurgitation(STR),right atrium diameter(DRA),right ventricle inner diameter(DRV),left ventricular ejection fraction(LVEF)and pulmonary artery pressure(PPA)in the systole were measured and recorded as main observation indexes.ResultsThe data of STR,DRA,DRV,LVEF,PPAin the 111 patients were divided into 4 groups:preoperation group,1 week postoperation group,3 months postoperation group and 1 year postoperation group. The data of pairs of the 4 groups were compared and analyzed by each of the5 observation indexes. There was no significant difference in the comparison between the 1 week postoperation group and the 3 months postoperation group on the STRand between the preoperation group and the 3 months postoperation group on the LVEF(P > 0.05),and the differences between the other groups were statistically significant(P <0.05).Correlation analysis showed that there was a significant positive correlation between STRand DRAand between STRand PPA before and after operation. There was no correlation between STRand DRVbefore operation,and there was a positive correlation after operation. There was no correlation between STRand LVEF before operation,and there was a negative correlation after operation. All patients′ New York Heart Association(NYHA)cardiac functional grading improved significantly after operation.ConclusionsAnnuloplasty ring in the treatment of functional tricuspid regurgitation has a better early and medium-term effect,which reduce the recurrence rate of tricuspid regurgitation post operation,restrict right atrial and right ventricular dilatation,reduce pulmonary arterial pressure,improve left ventricular function,thus improve the prognosis of the patients,which has clinical popularizing value and significance.更多还原