摘要
目的探讨超声心动图对小剂量左西孟旦联合经导管主动脉瓣置换术(TAVR)治疗老年重度主动脉瓣狭窄(AS)合并心力衰竭的疗效评价。方法选择2018年7月—2023年7月本院收治的62例老年重度AS并心力衰竭患者作为研究对象,对照组行TAVR治疗+标准抗心衰治疗,观察组在对照组基础上给予小剂量左西孟旦治疗。对比两组的超声心动图观察指标、心功能相关指标、心功能相关实验室指标、心功能分级、呼吸困难情况及不良反应。结果术前,两组室间隔厚度、LVEDD、LVESD、LVEF、AVPG、主动脉瓣瓣口面积、Tpe、QTcd水平比较,差异均无统计学意义(P>0.05);术后1个月,两组室间隔厚度与术前比较,差异无统计学意义(P>0.05);术后1个月,两组LVEDD、LVESD、主动脉瓣瓣口面积明显较术前降低,且观察组明显较对照组低(P<0.05);术后1个月,两组的LVEF、AVPG明显较术前升高,且观察组明显较对照组高(P<0.05)。术后1个月,对照组的Tpe、QTcd水平较治疗前明显升高,且明显高于观察组(P<0.05),观察组与术前对比无明显差异(P>0.05)。术前,两组的PCWP、SVR比较,差异无统计学意义(P>0.05);术后1个月,两组PCWP、SVR明显降低,且观察组明显较对照组低(P<0.05)。术前,两组GDF-15、sST2、ox-LDL-AblgM、NT-proBNP水平比较,差异无统计学意义(P>0.05);术后1个月,两组GDF-15、sST2、NT-proBNP明显降低,ox-LDL-AblgM明显升高,且观察组变化幅度明显较对照组高(P<0.05)。术前,两组心功能分级对比无明显差异(P>0.05),术后1个月,两组的心功能分级明显改善,且观察组改善优于对照组(P<0.05)。术前,两组呼吸困难症状对比无明显差异(P>0.05);术后1个月,两组呼吸困难症状改善明显,且观察组明显优于对照组(P<0.05)。本研究所有患者均完成治疗,观察组不良反应较对照组高,但组间对比无统计学意义(P>0.05)。结论小剂量左西孟旦联合TAVR可明显改善老年重度主动脉瓣狭窄合并心力衰竭的心功能,可能与其可降低血清GDF-15、sST2、NT-proBNP,升高ox-LDL-AblgM水平有关,超声心动图可用于评价患者的心功能相关指标变化,为临床提供参考意见。
Objective To evaluate the short-term efficacy of echocardiography in the treatment of elderly patients with severe aortic stenosis(AR)combined with heart failure by low-dose levosimendan and transcatheter aortic valve replacement(TAVR).Methods 62 elderly patients suffering from severe aortic stenosis complicated with heart failure who were admitted to our hospital from July 2018 to July 2023 were selected as the study objects.The control group received TAVR treatment plus standard anti-heart failure treatment,and the observation group received low-dose levosimondan treatment on the basis of the control group.Echocardiographic observation indexes,cardiac function related indexes,cardiac function related laboratory indexes,cardiac function grade,dyspnea and adverse reactions were compared between the two groups.Results Before surgery,there were no statistical significance in interventricular septal thickness,LVEDD,LVESD,LVEF,AVPG,aortic valve opening area,Tpe and QTcd levels between the two groups(P>0.05).At one month after surgery,compared with that before surgery there were no statistical significance in the thickness of interventricular septum(P>0.05).After surgery for one month,LVEDD,LVESD and aortic valvular orifice area of both groups were significantly lower than those before surgery,and the observation group was significantly lower than the control group(P<0.05).After surgery for one month,LVEF and AVPG in both groups were significantly higher than those before operation,and the observation group was significantly higher than the control group(P<0.05).After surgery for one month,the Tpe and QTcd levels in the control group were significantly higher than those before treatment,and significantly higher than those in the observation group(P<0.05),but there was no significant difference in the observation group compared with those before surgery(P>0.05).Before operation,there were no statistical significance in PCWP and SVR between the two groups(P>0.05).After surgery for one month,PCWP and SVR in both groups were significantly decreased,and the observation group was significantly lower than the control group(P<0.05).Before surgery,there were no statistical significance in GDF-15,sST2,ox-LDL-AblgM and NT-proBNP levels between the two groups(P>0.05).After surgery for one month,GDF-15,sST2 and NT-proBNP were significantly decreased,ox-LDL-AblgM was significantly increased,and the change range of observation group was significantly higher than that of control group(P<0.05).Before surgery,there was no statistical significance in cardiac function grading between the two groups(P>0.05).After surgery for one month,the cardiac function grading of the two groups were significantly improved,and the improvement of the observation group was better than that of the control group(P<0.05).Before operation,there was no statistical significance in dyspnea symptoms between the two groups(P>0.05).After surgery for one month,the dyspnea symptoms of both groups improved significantly,and the observation group was significantly better than the control group(P<0.05).In this study,all patients completed treatment,and the incidence of adverse reactions in the observation group were higher than those in the control group,but there was no statistical significance between the two groups(P>0.05).Conclusions Low-dose levosimendan combined with TAVR can significantly improve cardiac function in elderly patients with severe aortic stenosis complicated with heart failure,which may be related to the decrease of serum GDF-15,sST2,NT-proBNP,and the increase of ox-LDL-AblgM level.Echocardiography can be used to evaluate the changes of cardiac function related indicators in patients with severe aortic stenosis,and provide clinical reference.
作者
陆晓娴
胡国兵
Lu Xiaoxian;Hu Guobing(Department of Ultrasonic Medicine,Yijishan Hospital Affiliated to Wannan Medical College,Wuhu,Anhui 241000,China)
出处
《齐齐哈尔医学院学报》
2024年第1期58-63,共6页
Journal of Qiqihar Medical University
关键词
超声心动图
经导管主动脉瓣置换术
心力衰竭
主动脉瓣狭窄
心功能
预后水平
左西孟旦
Echocardiography
Transcatheter aortic valve replacement
Heart failure
Aortic valve stenosis
Cardiac function
Prognostic level
Levosimendan
