周达新,潘文志,管丽华,张蕾,张晓春,葛均波

• 1:复旦大学附属中山医院心内科

摘要(Abstract)：

目的经皮球囊主动脉瓣成形术(PBAV)是钙化性主动脉瓣狭窄(CAS)可选择的治疗手段。本研究观察了PBAV对CAS的短期疗效,并对初步的经验进行总结。方法入选2014年10月至2015年3月在复旦大学附属中山医院就诊,并行PBAV术的CAS患者。观察患者围术期及术后3个月的指标变化,包括跨瓣压差、超声心动图指标、NYHA心功能分级、N末端B型脑钠肽前体(NT-pro BNP)、生活质量评分以及并发症(包括出血、卒中、心律失常、心脏压塞、肾功能损害、心肌梗死、主动脉瓣反流加重及死亡)。结果共入选11例患者,均成功完成手术,围术期除1例术中一过性的左束支传导阻滞、1例术后低血压反应,未发生其他并发症。扩张后即刻,导管测得的最大跨瓣压差由术前(86.6±22.4)mm Hg(1 mm Hg=0.133 k Pa)降至(53.2±18.7)mm Hg(P<0.001)。出院前评估显示,患者超声心动图测得的最大跨瓣压差由术前(111.0±29.2)mm Hg降至(85.5±26.4)mm Hg,平均跨瓣压差由术前(67.1±19.6)mm Hg降至(48.5±12.2)mm Hg(P<0.001),主动脉瓣瓣口面积由术前(0.58±0.10)cm2升至(0.75±0.15)cm2,而左心房内径、左心室内径及左心室射血分数没有变化。所有患者EQ5D生活质量评分均提高[(54.5±15.9)分比(64.6±13.3)分,P<0.01]。3例患者NYHA心功能分级没有改变,其余均改善1级(P<0.01)。1例患者于术后2个月因心力衰竭死亡。3个月随访时,9例完成完整的评估和检查,经超声心动图测得的跨瓣压差、主动脉瓣瓣口面积、左心房内径、左心室内径及左心室射血分数和lg(NT-pro BNP)、NYHA心功能分级与出院时比较,差异均无统计学意义(P>0.05),EQ5D生活质量评分略有提高[(57.6±9.4)分比(63.5±10.6)分,P=0.04]。结论初步经验显示,使用8 F、最大内径为18 mm球囊行PBAV术是可行的,安全性高、并发症发生率低,并可取得即刻和短期的血流动力学及症状的中度改善。然而,其中远期的效果有待于进一步研究。

关键词(KeyWords)： 经皮球囊主动脉瓣成形术;主动脉瓣狭窄;疗效

Abstract:

Keywords:

基金项目(Foundation): 上海市科委产学研项目子课题(14DZ1941500)

作者(Author): 周达新,潘文志,管丽华,张蕾,张晓春,葛均波

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