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老年患者经皮球囊二尖瓣扩张术的远期疗效
long-term outcomes in elderly patients a.
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内容提示：老年患者经皮球囊二尖瓣扩张术的远期疗效
long-term outcomes in elderly patients after percutaneous ballon mitral valvuloplasty
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老年患者经皮球囊二尖瓣扩张术的远期疗效
官方公共微信作者：&作者本人请参看导师姓名：&学位授予单位：&授予学位：硕士学位年度：2011专业：&关键词：&&&&摘要:（摘要内容经过系统自动伪原创处理以避免复制，下载原文正常，内容请直接查看目录。）研讨配景：风湿性心脏病(Rheumatic Heart Disease， RHD)简称风芥蒂，是风湿性炎症进程而至瓣膜伤害。最易侵占二尖瓣，其次为自动脉瓣，纯真的二尖瓣狭小占风芥蒂的25%。风行病学查询拜访成果显示，固然我国风芥蒂得病率有所降低，但同时显示得病年纪延迟的景象，老年患者所占比例呈逐年增高趋向，是以对老年风芥蒂患者的医治成为血汗管病的主要课题。今朝关于风湿性二尖瓣狭小(Rheumatic Mitral Stenosis， MS)的医治办法有内科手术(包含直视分别术、闭式分别术、人工瓣膜置换术)和经皮二尖瓣球囊扩大术(Percutaneous Mitral Balloon Valvuloplasty， PBMV)。跟着PBMV技巧的完美和闇练，PBMV至多可获得与二尖瓣闭式分别术相当的近、远期疗效，乃至可与开胸直视二尖瓣分别术媲美，PBMV已成为医治中青年二尖瓣狭小的首选办法。而老年MS患者行PBMV与中青年比拟其平安性及疗效有何差别，年纪能否是影响疗效的风险身分，对此国际少有报导，国外报导成果也纷歧致。由此本研讨对491例行PBMV的MS患者停止回想性剖析，比拟了老年及中青年患者的临床特色及近远期疗效，并商量了影响远期疗效的风险身分，旨在为临床运用PBMV医治老年MS供给实际根据。目标：1。剖析行PBMV的老年与中青年MS患者的临床特色及超声心动图特点；2。比拟老年与中青年MS患者PBMV的即刻疗效及并发症；3。对老年与中青年MS患者PBMV的远期疗效停止比拟；4。商量影响疗效的风险身分，不雅察年纪能否是影响远期疗效的自力风险身分。办法：行PBMV的491例MS患者(消除再次PBMV患者)分为老年组(年纪≥60岁)，96例，均匀年纪64。2±3。14岁；中青年组(年纪《60岁)，395例，均匀年纪45。5±9。7岁。一切患者均于术前记载临床特点，术前术后惯例行多普勒超声心动图，记载术中血活动力学参数，每一年停止门诊随访并心脏超声评价，记载临床心功效、有没有再次PBMV、二尖瓣置换术(MVR)、逝世亡等；评价瓣口面积(MVOA)，有没有再狭小。对以上材料停止回想性剖析。成果：1。两组性别比、心功效、左室射血分数(LVEF%)，既往二尖瓣分别术无差别性，老年归并房颤(51%和33。2%，P=0。001)、冠芥蒂明显增多(6。3%和0。5%，P=0。001)。白叟组均匀二尖瓣返流(MR)明显重于中青年组(0。93±0。67和0。65±0。62，P=0。001)。与中青年比拟，老年组超声积分较高(7。9±1。8和6。9±1。9，P=0。001))。经由过程Wilkin积分分级显示，老年组较中青年组二尖瓣瓣膜和婉性较差(2。0±0。4和1。8±0。3，P=0。005)，瓣膜明显增厚(2。3±0。5和2。1±0。3，P=0。003)，和瓣膜明显钙化(1。9±0。7和1。7±0。4，P=0。001)。两组术前MVOA无差别性。两组术前左房压(LAP)类似，中青年组有更高均匀跨瓣压力阶差(MVG)(14。2±5。4和12。1±3。9，P=0。001)。2。老年组与中青年组手术胜利率分离为92。7%和97%，但未构成统计学差别。二者心包填塞、严重MR、术后24小时栓塞、逝世亡等并发症产生率均类似。老年组球囊最初扩大直径小于中青年组(24。9±1。12和25。4±1。35，P=0。002)；两组球囊扩大掉败率无统计学差别。手术胜利后，老年人术后均匀LAP高于中青年(16。2±5。2和15。1±4。1，P=0。027)。两组术后均匀MVG无差别性。老年组手术后即MVA明显小于中青年组(1。91±0。22和2。01±0。18，P=0。001)，老年组术后瓣口面积增年夜比例明显小于中青年组。两组术后MR水平类似。3。两组随访率无差别性(95。5%和94。5%，P=1。00)，两组随访时光为12一96个月，均匀随访时光无差别性(39。9±24。6月和41。2±21。8月，P=0。658)，随访停止后，老年组MVA仍低于中青年组分离为1。61±0。21 cm2和1。67±0。21cm2，P=0。013))，但两组再狭小率类似(23。5%和19。9%，P=0。495)。老年组不良事宜产生率略高于中青年组，但未达统计学差别(27。4%和18。6%，P=0。098)。青年组心功效改良水平优于老年组(1。80±0。77和2。07±0。77，P=0。004)；老年组不良事宜归并归并心功效Ⅲ及以上明显高于青年组(34。1%和21。3%，P=0。016)。4。多身分回归剖析，心功效Ⅲ级及以上归并不良事宜的自力风险身分为房颤(OR2。116，95% CI1。246一3。592， P=0。006)、术前心功效(OR2。263，95% CI1。355一3。777， P=0。002)、Wilkins积分(OR1。232，95% CI1。061一1。429， P=0。006)、即刻MVA(OR0。056，95% CI0。010一0。313，P=0。001)、术后MR(OR 1。725，95% CI1。121一2。664， P=0。013)，术后均匀LAP(OR1。113，95% CI 1。008一1。229，P=0。034)；年纪不是影响疗效的自力风险身分之一。结论：1。与中青年比拟，老年风湿性二尖瓣狭小患者归并房颤、冠芥蒂较多，瓣膜超声积分明显高，常归并二尖瓣返流；2。经由过程PBMV操作改进，与中青年比拟，老年手术即刻后果，手术平安性与胜利率、并发症类似，但手术球囊扩大直径小于中青年，扩大后瓣口面积小于中青年；3。远期疗效，老年人MS行PBMV后，虽然扩大即刻瓣口面积较小，与中青年比拟，再狭小率类似，不良事宜产生率类似，但心功效改良水平低于中青年。远期不良事宜归并心功效Ⅲ级产生率高于中青年人；4。多身分logistic回归剖析显示，Wilkins积分、房颤、术前心功效、即刻MVA、术后MR为远期疗效的猜测身分，年纪不影响远期疗效。综上所述，老年MS行PBMV后平安有用，但手术操作有其特别性，年纪不是PBMV限制身分。Abstract:Research background: rheumatic heart disease (Rheumatic Heart, Disease, RHD) referred to as the wind feeling, rheumatic inflammatory process and valve damage. The occupation of mitral valve, followed by aortic valve, pure mitral stenosis accounted for 25% of the wind feeling. Epidemiological survey results show that although China's wind feeling prevalence decreased, but at the same time delay show sick age scene, the proportion of elderly patients with the increasing trend, is to treat patients with old grudges wind has become a major issue of cardiovascular disease. Stenosis Percutaneous (Mitral), Rheumatic Balloon Valvuloplasty PBMV (), is currently being treated for the treatment of rheumatic mitral stenosis (Mitral) (MS). With the perfect and dark PBMV skills, PBMV can be obtained with the mitral valve closed type were quite close, long-term efficacy, and can be comparable with open chest surgery, PBMV has become the first choice for young people in the treatment of small mitral valve. While the elderly patients with PBMV MS and the young people to compare their safety and efficacy of the difference, whether the age is the risk factor for efficacy, which has been reported that the report of foreign countries, the results are also different. This study of 491 cases of MS PBMV patients to stop thinking, compared with the elderly and middle-aged patients with clinical characteristics and long-term efficacy, and to discuss the risk factors affecting the long-term efficacy, designed to use PBMV for clinical treatment of elderly MS. Target: 1. Analysis of the clinical characteristics and echocardiographic characteristics of MS in elderly patients with PBMV, 2. Immediate effect and complications of MS in elderly patients with PBMV, 3. The long term efficacy of PBMV in elderly patients with MS were compared with 4. To discuss the effect of risk factors, can observe the long-term therapeutic effects of age are independent risk factors. Methods: 491 cases of patients with MS PBMV (again to eliminate PBMV patients) were divided into elderly group (age = 60 years), 96 cases, average age 64. 2 + 3. 14 young group (aged 60 years), 395 cases, average age 45. 5 + 9. 7 years old. All patients were recorded before and after operation. The clinical characteristics were recorded by Doppler echocardiography, and the mechanical parameters were recorded. The clinical efficacy was recorded. The clinical efficacy was recorded. The clinical efficacy, PBMV, mitral valve replacement (MVR) and death were recorded. Analysis of the above materials to stop thinking. Results: 1. Two groups of sex ratio, heart effect, left ventricular ejection fraction (LVEF%), the past mitral valve were no difference, elderly patients with atrial fibrillation (51% and 33. 2%, P=0. 001), coronary heart disease increased significantly (6. 3% and 0. 5%, P=0. 001). The old uniform group of mitral regurgitation (MR) was significantly heavier than in the young group (0. 93 + 0. 67 and 0. 65 + 0. 62, P=0. 001). Compared with the young and middle-aged, the elderly group has a higher score of ultrasonic (7. 9 + 1. 8 and 6. 9 + 1. 9, P=0. 001)). Show through Wilkin integral grade, elderly group than in young group (2 mild mitral valve. 0 + 0. 4 and 1. 8 + 0. 3, P=0. 005), the valve was significantly thickened (2. 3 + 0. 5 and 2. 1 + 0. 3, P=0. 003), and valve calcification (1. 9 + 0. 7 and 1. 7 + 0. 4, P=0. 001). There was no difference between the two groups before MVOA. The left atrial pressure (LAP) in the two groups was similar to that in the middle and young people, and there were more uniform cross valve pressure difference (MVG) (14). 2 + 5. 4 and 12. 1 + 3. 9, P=0. 001). 2. The elderly group and the young group were 92. 7% and 97%, but not a statistically significant difference. The complications such as two were similar to those of the patients with complications such as severe MR, severe, 24 hours after operation. The balloon in the old group was initially expanded in diameter less than in the middle of the youth group (24. 9 + 1. 12 and 25. 4 + 1. 35, P=0. 002), there was no statistical difference between the two groups. After the operation, the average LAP was higher in the elderly patients (16. 2 + 5. 2 and 15. 1 + 4. 1, P=0. 027). There was no difference between the two groups after the operation of MVG. After surgery, the MVA was significantly less than that in the young group (1. 91 + 0. 22 and 2. 01 + 0. 18, P=0. 001), the proportion of the increase in the size of the flap in the old group was significantly smaller than that in the middle and young group. MR level was similar in the two groups. 3. There was no difference in two groups (95. 5% and 94. 5%, P=1. Two), the 12 groups were followed up for 96 months, the average follow-up time was 00 (39). 9 + 24. June and 41. 2 + 21. August, P=0. 658), after the cessation of the follow-up, the MVA of the aged group was still lower than that of the young group of 1. 61 + 0. 21 cm2 and 1. 67 + 0. P=0, 21cm2. (013)), but the two groups were similar to the narrow rate (23. 5% and 19. 9%, P=0. 495). The rate of adverse issues in the old group was slightly higher than that in the young group, but not to the statistical difference (27. 4% and 18. 6%, P=0. 098). The improvement of cardiac function in young group was better than that in old age group (1. 80 + 0. 77 and 2. 07 + 0. 77, P=0. 004), the old group of ill matters to merge the heart and the effect of the heart目录:中文摘要6-9ABSTRACT9-13符号说明15-16前言16-17资料和方法17-20结果20-22讨论22-32结论32-33附图表33-37参考文献37-42综述42-67&&&&参考文献59-67致谢67-68学位论文评阅及答辩情况表68原价：￥20.00元折价：￥5.00元分享到：相关文献|就医导诊台在线时间：9:00-18:00
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