长期生存的风湿性心脏病71例临床分析  

Clinical analysis of 71 long-term survived patients with rheumatic heart disease

作　　者：殷兆芳[1] 吴士尧[1] 严毓勤[1] 陈元美[1] 朱文敏[1] 许左隽[1] 刘平章 

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,上海200011 [2]安徽省灵璧县第二人民医院内科

出　　处：《中国综合临床》2005年第12期1060-1062,共3页Clinical Medicine of China

摘　　要：目的了解长期生存的风湿性心脏病患者的流行病学及临床特点、治疗情况和生存状态,为风湿性心脏病临床治疗及进一步研究提供依据。方法采用调查登记方法对71例生存期限>30年的风湿性心脏病患者进行2年随访,对其流行病学和临床资料进行回顾性分析。结果①71例患者发病最早15岁,最晚52岁,发病年龄(29.14±5.73)岁,生存期限(36.57±5.84)年;②合并呼吸道感染的发生率为26.8%,无合并疾病者占29.6%;心房颤动的发生率为85.72%,栓塞的发生率为28.2%;而规范的抗栓治疗仅32例(53.3%);手术治疗19例(26.5%);③9例死亡患者中因心力衰竭加重致死者占66.7%,栓塞致死者占22.2%;随访两年期间平均住院次数1.61次/(年·人);④年龄与发病年龄、生存年限显著正相关(P<0.01),与左心室舒张末期内径、二尖瓣瓣口面积显著负相关(r分别为-0.313和-0.333,均为P<0.05);发病年龄与左心室舒张末期内径呈显著负相关(r=-0.352,P<0.05)。结论左心室舒张末期内径可能是风湿性心脏病的一个有价值的预后指标,应进一步加强风湿性心脏病合并心房颤动患者抗凝的公共宣教和临床实践。Objective To explore the epidemiology, clinical characteristics and treatment as well as survival situation of long-term survived eases with rheumatic heart disease （RHD） and to provide basis for further study and treatment. Methods Clinical and epidemiologieal data of 71 patients with chronic rheumatic heart disease surviving more than 30 years who were followed up for 2 years were retrospectively analyzed. Results 15 years old age was the smallest and 52 years old age was the latest when rheumatic heart disease occurred in 71 cases,on average age of （29.14±5.73） and with the average surviving period of （36.57±5.84） years; 19 （26,8%） of 71 RHD eases suffered from respiratory tract infection while the patients who were not complicated with other diseases accounted for 29.6% ,but only 32 eases（ 53.3% ） underwent effective antiembolization treatment and 19 eases were treated surgically （26.5%） ; the incidence of atrial fibrillation and embolism was 85, 72% and 28.2%, respectively, the eases died of worsened heart failure and embolization in 9 dead eases accounted for 66.7% and 22, 2% ,respectively ; the average hospitalization time was 1.61 per year during 2-year follow up period; age was positively correlated with RHD attack and survival period （ P 〈 0.01 ） while negatively correlated with mitral valve area and left ventrieular end-diastolic diameter（ r = -0.313 and - 0. 333, P 〈 0.05, for each ） ; RHD attack age was significantly negatively correlated with left ventrienlar diameter（ r = -0. 352,P 〈 0.05 ）. Conclusion Left ventrieular end-diastolic diameter may be a valuable prognosis index for rheumatic heart disease, so antieoagulation to rheumatic heart disease complicated with atrial fibrillation should be strenghened.

关 键 词：风湿性心脏病 左心室舒张末期内径 二尖瓣瓣口面积 心房颤动 抗凝 

分 类 号：R541.2[医药卫生—心血管疾病]