心瓣膜置换术同期行冠状动脉旁路移植术患者长期预后的危险因素探讨  

Risk factors for the long-term prognosis of patients undergoing heart valve replacement and coronary artery bypass grafting

作　　者：缪丙荣[1] 

机构地区：[1]江苏省徐州市中心医院心脏外科,221009

出　　处：《临床外科杂志》2012年第11期785-786,共2页Journal of Clinical Surgery

摘　　要：目的探讨影响心瓣膜置换术同期行冠状动脉旁路移植术（CABG）患者长期预后的危险因素。方法57例同期行心脏瓣膜置换术和冠状动脉旁路移植术的患者，同行CABG和主动脉手术13例，同行CABG和双瓣膜手术16例，同行CABG和二尖瓣手术28例；移植血管（1．97±1．36）支。通过随访获取数据，对潜在危险因素先用Cox比例风险模型进行单变量分析，再将有统计学意义（P〈0．05）的危险因素纳入Cox多变量回归。结果失访2例，随访55例，平均随访时间（57．37±13．98）个月，随访期间共7例死亡；高龄（年龄〉70岁）、术前合并糖尿病、有心肌梗死史、慢性肺疾病和左心室射血分数≤40％为影响心瓣膜置换术和CABG同行患者长期预后的独立危险因素。结论高龄、术前合并糖尿病、有心肌梗死史、有慢性肺疾病和左心室射血分数过低（≤40％）是影响两类手术同行患者长期预后的危险因素。Objective To investigate the risk factors for the longterm prognosis of patients un dergoing heart valve replacement （HVR） and coronary artery bypass grafting （ CABG ）. Methods Fifty seven patients who underwent HVR combined with CABG in our center were selected as the study objects, CABG combined with aortic operation were performed in 13 cases,CABG combined with double valve re placement were performed in 16 cases and CABG combined with mitral surgery were peformed in 28 cases; The mean number of the graft vessels was（ 1.97 ± 1.36 ）. The followup data were collected. Cox propor tional hazard model was used to perform the univariate and muhivariate analysis of risk factors. Results Fiftyfive patients were followed up with the mean time of（57.37 ± 13.98 ）months. Two patients were out of followup and 7 patients died ; Cox proportional hazard model revealed that age 〉 70 years, preexisting diabetes, history of myocardical infarction, chronic lung diseases, previous infarction, and left ventrieular e jection fraction（LVEF） ≤40% were the independent risk factors for the longterm prognosis in patients undergoing HVR combined with CABG. Conclusion Age, preexisting diabetes, history of myocardical in farction, chronic lung diseases, previous infarction, and LVEF ≤40% were the risk factors for the longterm prognosis in patients undergoing HVR combined with CABG.

关 键 词：冠状动脉旁路移植术 心瓣膜置换术 长期预后 危险因素 

分 类 号：R655[医药卫生—外科学]