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目的:探讨妊娠合并风湿性心脏病二尖瓣狭窄患者球囊扩张术中的射线的防护。方法:选择风湿性心脏病二尖瓣狭窄合并妊娠患者30例,中度狭窄20例,重度狭窄10例,二尖瓣口面积平均(0.9±0.4)cm2。妊娠5～9个月。介入术前静脉使用利尿剂减轻心力衰竭症状,术中每个患者腹部及腰背部垫上防辐射铅垫子,尽量减少曝光时间和手术操作时间。结果:30例妊娠患者通过球囊扩张后,左心房平均压显著减小(P<0.01),左房室瓣跨瓣压差显著减小(P<0.01),肺动脉压力明显下降(P<0.01),二尖瓣口面积明显扩大(P<0.01);二尖瓣区舒张期隆隆样杂音从中重度减为轻度;胸闷、气促、呼吸困难等症状明显缓解,心功能明显改善。随访3个月～6年,平均(52±15)个月,密切观察下足月顺产3例,剖腹产27例,无胎儿畸型及严重并发症的发生。结论:在严格的X线屏蔽防护下,经皮穿刺球囊扩张术是妊娠合并风湿性心脏病二尖瓣中重度狭窄患者有效的治疗方法,可以减轻症状,提高生活质量,改善妊娠患者预后。
Objective: To investigate the radiation protection during balloon dilation in patients with mitral stenosis in pregnancy complicated with rheumatic heart disease. Methods: Thirty patients with rheumatic mitral stenosis complicated with pregnancy, 20 moderate stenosis, 10 severe stenosis and mitral valve area average 0.9 ± 0.4 cm2. 5 to 9 months of pregnancy. Interventional preoperative intravenous diuretics to reduce heart failure symptoms, each patient in the abdomen and waist and back pad radiation protection lead mat, to minimize exposure time and operation time. Results: The mean pressure of left atrium decreased significantly in 30 pregnant patients (P <0.01), the pressure difference of left atrioventricular valve was significantly decreased (P <0.01) and the pressure of pulmonary artery was significantly decreased (P <0.01) ), Mitral valve area was significantly enlarged (P <0.01); mitral valve area diastolic rumbling noise from moderate to severe; chest tightness, shortness of breath, dyspnea and other symptoms were significantly alleviated, cardiac function improved significantly. All the patients were followed up for 3 months to 6 years, with an average of (52 ± 15) months. Three cases of full-term follow-up and 27 cases of caesarean section were observed. No fetal malformations and serious complications occurred. Conclusion: Under strict X-ray shield protection, percutaneous balloon dilatation is an effective treatment for patients with moderate to severe mitral stenosis in pregnancy complicated with rheumatic heart disease. It can reduce the symptoms, improve the quality of life, and improve the prognosis of pregnant patients.