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目的:观察介入治疗室间隔缺损(VSD)后心脏形态的变化规律,评价培哚普利对VSD患者封堵后左室形态、功能和肺动脉收缩压的干预影响。方法:入选经胸超声心动图(TTE)测得VSD<15.0 mm或伴有膜部瘤时基底部直径<20 mm的20例VSD患者,分成治疗组和对照组。2组均于介入治疗前1 d开始予肠溶阿司匹林200 mg/d×1个月,然后100 mg/d×5个月,治疗组加服培哚普利2 mg/d×6个月。术前,术后24 h、3个月、6个月行TTE和心电图检查,心室容积和左室射血分数采用面积长度法测定,连续多普勒根据三尖瓣反流估测肺动脉收缩压。结果:与术前相比,术后24 h左室高动力循环状态改善,左室射血分数降低(P<0.05),以后维持正常水平而保持正常左室功能。术后肺动脉收缩压虽降低,但与术前比差异均无统计学意义(P>0.05)。左房室内径、容积术后较术前差异无统计学意义(P>0.05)。治疗组经培哚普利口服6个月后,左房内径、左室内径和容积、肺动脉收缩压、左室射血分数和左室短轴缩短率与对照组相比均差异无统计学意义(P>0.05)。结论:由于膜部VSD一般均较小,术后24 h左室高动力循环状态减轻,培哚普利对左心和肺动脉压力及右心功能无影响。
OBJECTIVE: To observe the changes of cardiac morphology after interventional treatment of ventricular septal defect (VSD) and to evaluate the effect of perindopril on left ventricular morphology, function and pulmonary artery systolic pressure after closure in VSD. METHODS: Twenty patients with VSD who had VSD <15.0 mm or basal diameter <20 mm with meningioma were included in the transthoracic echocardiography (TTE), and were divided into treatment group and control group. Two groups were given aspirin 200 mg / d for 1 month and then 100 mg / d for 5 months. The patients in the treatment group were treated with perindopril 2 mg / d for 6 months. Preoperative, postoperative 24 h, 3 months, 6 months underwent TTE and ECG, ventricular volume and left ventricular ejection fraction were determined by the area length method, continuous Doppler estimated tricuspid regurgitation pulmonary artery systolic pressure . Results: Compared with preoperative, left ventricular hyperparathyroidism improved and left ventricular ejection fraction decreased 24 h after operation (P <0.05). After that, the normal left ventricular function was maintained. Postoperative pulmonary artery systolic pressure was reduced, but compared with the preoperative difference was not statistically significant (P> 0.05). Left atrioventricular diameter, volume after surgery was no significant difference (P> 0.05). There was no significant difference in the left atrial diameter, left ventricular diameter and volume, pulmonary artery systolic pressure, left ventricular ejection fraction and left ventricular fractional shortening after 6 months of treatment with perindopril (P> 0.05). CONCLUSION: Perioperative effects of perindopril on left ventricular and pulmonary arterial pressure and right ventricular function were unobvious because VSD of the membrane was generally small and the left ventricular hyper-kinetic state was alleviated 24 hours after operation.