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经皮主动脉瓣球囊扩张术治疗老年钙化性主动脉瓣狭窄并发心功能不全患者的临床效果
作者:张丽娥  杨侠  杨翠玲 
单位:西安交通大学第二附属医院 干2病房, 陕西 西安 710004
关键词:主动脉瓣球囊扩张术 主动脉瓣狭窄 心功能不全 临床疗效 
分类号:R459.9;R652.4
出版年·卷·期(页码):2019·38·第十一期(1315-1319)
摘要:

目的:探讨经皮主动脉瓣球囊扩张术(percutaneous balloon dilatation of aortic valve,PBAV)治疗老年钙化性主动脉瓣狭窄(calcified aortic stenosis,CAS)并发心功能不全患者的临床疗效。方法:选取2015年6月至2017年6月西安交通大学第二附属医院收治的64例老年钙化性主动脉瓣狭窄并发心功能不全患者,采用随机数字表法将患者分为对照组(32例)和观察组(32例)。对照组采用药物治疗,观察组采用PBAV治疗,观察和比较两组患者治疗前治疗后超声心动图指标[最大跨瓣压差、平均跨瓣压差、主动脉瓣瓣口面积、左房内径(LAD)、左室收缩期末期内径(LVESD)、左室舒张期末内经(LVEDD)、左室舒张期容积(LVEDV)、左室射血分数(LVEF)、NYHA心功能分级],同时比较两组患者治疗后生活质量评分及治疗后1个月并发症的发生率。结果:治疗后观察组患者最大跨瓣压差、平均跨瓣压差、主动脉瓣瓣口面积显著低于对照组,差异具有统计学意义(P<0.05);两组LAD、LVEDD、LVEDV、LVEF差异无统计学意义(P>0.05);观察组患者NYHA心功能分级显著低于对照组,观察组患者的健康感觉、躯体感觉、睡眠状态等生活质量评分均显著高于对照组,差异具有统计学意义(P<0.05)。治疗后1个月对照组和观察组的并发症发生率分别为40.63%、31.25%,差异无统计学意义(P>0.05)。结论:PBAV治疗老年钙化性主动脉瓣狭窄疗效确切,对无法进行经导管主动脉瓣置换术的患者可作为备选方案之一。

Objective: To investigate the clinical effect of PBAV in the treatment of senile CAS complicated with cardiac insufficiency. Methods: From June 2015 to June 2017, 64 patients with senile CAS complicated with cardiac insufficiency were selected. All patients were randomly divided into control group (n=32) and observation group (n=32).The control group was treated with drug therapy and the observation group with percutaneous aortic valve balloon dilatation. The indexes of echocardiography (maximum transvalve pressure difference, mean transvalve pressure difference, aortic valve area, LAD, LVESD, LVEDD, LVEDV, LVEF) and NYHA cardiac function grading were compared between the two groups before and after operation. And the quality of life score and the incidence of complications 1 month after operation were compared between the two groups. Results: Compared with the control group, the maximum transvalve pressure difference, the average transvalve pressure difference and the aortic valve orifice area in the observation group were significantly decreased (P<0.05). There was no significant difference in LAD, LVEDD, LVEDV, LVEF between the two groups after treatment. After treatment, compared with the control group, the NYHA cardiac function grade of the observation group was significantly lower, the scores of health feeling, somatosensory, sleep state and other quality of life of the patients in the observation group were significantly higher (P<0.05).One month after treatment, the incidence of complications in the control group and the observation group was 40.63% and 31.25%, respectively (P>0.05). Conclusion: Percutaneous balloon aortic valvuloplasty is effective in the treatment of senile calcified aortic stenosis.

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