退行性主动脉瓣病变围术期死亡的危险因素分析  

Risk factors for in-hospital mortality of patients with degenerative aortic valve disease

作　　者：金磊[1] 张浩[1] 王崇[1] 郎希龙[1] 唐昊[1] 韩林[1] 徐志云[1] 

机构地区：[1]第二军医大学长海医院胸心外科,上海200433

出　　处：《中华临床医师杂志（电子版）》2012年第18期102-104,共3页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的分析与退行性主动脉瓣病变围术期死亡相关的危险因素,确立与围术期死亡相关的独立危险因素,以提高该疾病围术期的安全性。方法回顾性收集1998年1月1日至2008年12月31日于我院因退行性主动脉瓣病变而行主动脉瓣置换术患者共262例的临床资料。全组患者年龄(59.5±11.3)岁,男189例(72.1%),女73例(27.9%)。根据主动脉瓣病变的病因学诊断,将患者分为单纯主动脉瓣狭窄手术组(n=10)、单纯主动脉瓣关闭不全手术组(n=149)及主动脉瓣狭窄合并关闭不全手术组(n=103)。采用多因素Logistic回归分析与围术期死亡相关的危险因素。结果总在院死亡率为3.05%(8/262)。多因素Logistic回归分析发现,脑栓塞(OR=2.23,95%CI:1.39～3.68)、术前危重状态(OR=3.86,95%CI:1.90～6.68)、左心室射血分数(OR=2.93,95%CI:1.54～5.74)、心室颤动(OR=2.72,95%CI:1.52～4.93)、肺部感染(OR=1.43,95%CI:1.08～1.76)、急性肾功能衰竭(OR=4.34,95%CI:2.98～9.77)为退行性主动脉瓣病变手术围术期死亡的独立危险因素。结论通过多因素Logistic回归分析发现,脑栓塞、术前危重状态、左心室射血分数、心室颤动、肺部感染、急性肾功能衰竭这6个因素为影响退行性主动脉瓣病变手术围术期死亡的独立危险因素。Objective To analyze the risk factors for in-patient mortality of patients with degenerative aortic valve disease.Methods From January 1998 to December 2008,records of 262 consecutive patients who underwent aortic valve replacement due to degenerative aortic valve disease in Changhai hospital were collected.Univariate analysis was used to identify the potential risk factors and multivariate logistic regression was used to determine the independent risk factors.Results In-patient mortality of all 262 patients was 3.05%.Six variables including cerebrovascular embolism(OR=2.23,95% CI:1.39-3.68),critical preoperative state(OR=3.86,95% CI:1.90-6.68),left ventricular ejection fraction(OR=2.93,95% CI:1.54-5.74),ventricular fibrillation(OR=2.72,95% CI:1.52-4.93),lung infection(OR=1.43,95% CI:1.08-1.76),acute renal failure(OR=4.34,95% CI:2.98-9.77)were independently correlated with in-patient patient mortality.Conclusions The following risk factors were associated with the in-patient mortality of patients with degenerative aortic valve disease:cerebrovascular embolism,critical preoperative state,left ventricular ejection fraction,ventricular fibrillation,lung infection,acute renal failure.

关 键 词：主动脉瓣 手术期间 死亡 危险因素 退行性瓣膜病 

分 类 号：R654.2[医药卫生—外科学]