倾向分值匹配法对2种手术方式治疗左室室壁瘤的比较分析  

A Propensity Score-matched Study of Outcomes Following Different Repair Techniques For Left Ventricular Aneurysm

作　　者：凤玮[1] 樊红光[1] 郑哲[1] 胡盛寿[1] 

机构地区：[1]中国医学科学院北京协和医科大学心血管病研究所阜外心血管病医院,北京100037

出　　处：《实用临床医药杂志》2009年第5期5-8,共4页Journal of Clinical Medicine in Practice

基　　金：国家十一五科技支撑计划(2006BAI01A09);北京市科委资助项目(D0906004040391)

摘　　要：目的评估改良左室成形（VR）及线性缝合（LR）治疗左室室壁瘤的近期、远期结果。方法1995--2005年，本院共收治了514例左室室壁瘤患者，其中145例行改良内荷包环缩左室成形，352例行标准的线性缝合。应用倾向分值匹配法选择202例具有相似术前术中特征的患者（左室成形组和线性缝合组各101例），比较其近期、远期临床结果。结果2组患者经倾向分值匹配后具有相似的疾病特征、并存疾病、心脏病史及解削。院内死亡率均为2．0％，随访期内死亡率均为11．9％。术后VR组左室射血分数（LVEF）较LR组提高的明显（P〈0．01）。2组在再入院率、MACCEs发生率均有显著的统计学差异（P〈0．01）。Cox风险比例模型分析发现线性缝合是MACCEs发生和再入院的独立风险因子（HR：1．86，9596 CI=1．15～3．02，P=0．012）。结论手术方式的不同并不影响手术的近远期死亡率，但VR组较LR组术后LVEF提高的多，MACCEs发生和再入院率低，均有显著性差异。Objective To evaluate recent and long-term outcomes of modified left ventricular reconstruction with linear repair of post infarction left ventricular aneurysm. Methods From 1995 to 2005, 514 patients were consecutively operated on for dyskinetic left ventricular aneurysm after anterior myocardial infarction （MI） with modified ventrieular reconstruction （VR） technique in 145 and linear repair （LR） in 352 patients. Using the propensity score-matching method, we selected 202 patients （101 LRs vs 101 VRs） with similar pre- and intra-operative characteristics and compared their recent and long-term clinical outcomes. Results After propensity score matching, the two groups of patients were similar with regard to baseline disease characteristics, comorbidities, cardiac history and anatomy, operative mortality （2.0% LRs vs 2.0% VRs, P = NS） and Overall long term mortality （Mortality： 11.9% LR vs 11.9% VR, P = ns） were the same between the two groups. The increment of LVEF in VR group was more significant than that in LR group. There was a statistically significant difference between LR and VP patients in the incidence MACCEs （29.7 % LR vs 13.9 % VR, P 〈 0. 001） and the rate hospital readmissions （51.5 % LR vs 30. 7% VR, P 〈 0.001）. Cox analysis confirmed that LR was independent risk factor for MACCEs （HR：2.02,95 % CI= 1.07--3.80, P = 0. 031）andhospitalreadmission（HR： 1.86,95 % CI = 1.15 --3.02, P = 0. 012）. Conclusion The technique of repairing left ventricular aneurysm did not affect the early and late mortality. But VR results is more significant in LVEF improvement, fewer MACCEs and lower rate of hospital readmission than LR.

关 键 词：倾向分值匹配法 左心室室壁瘤 改良左室成形 

分 类 号：R654[医药卫生—外科学]