大左心室心脏瓣膜病术后左心室形态及收缩功能变化的系统评价  

Changes of Left Ventricular Morphology and Contractile Function after Heart Valve Replacement of Patients with Valvular Heart Disease and Giant Left Ventricle:A Systematic Review

作　　者：王寅[1] 董念国[1] 史嘉玮[1] 尹平[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管外科,武汉430000 [2]华中科技大学同济医学院公共卫生学院 流行病与卫生统计学教研室,武汉430000

出　　处：《中国胸心血管外科临床杂志》2013年第2期125-134,共10页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家"十二五"科技支撑计划项目(2011BAI11B19);国家自然科学基金项目(81170214)~~

摘　　要：目的系统评价大左心室心脏瓣膜病患者行心瓣膜置换术前和术后反映左心室收缩功能的相关超声心动图指标变化。方法计算机检索建库至2012年6月间中国生物医学文献数据库、维普中文科技期刊数据库、万方数据资源系统、中国期刊全文数据库、PubMed、ScienceDirect,纳入大左心室心脏瓣膜病患者行心瓣膜置换术的文献,评价纳入文献质量,提取相关数据进行Meta分析,比较心脏瓣膜病患者术前、术后超声心动图指标变化差异。统计学分析采用R2.15.2软件。结果最终纳入12篇回顾性队列研究,患者833例。纳入文献质量较高。Meta分析结果显示,左心室舒张期末内径(LVEDD)在术后2周内、6个月、1年、2～3年较术前分别下降11.72 mm[95%CI(9.52,13.92),P<0.001],20.02 mm[95%CI(18.28,21.76),P<0.001],22.48 mm[95%CI(19.55,25.40),P<0.001],24.69 mm[95%CI(22.21,27.18),P<0.001];左心室收缩期末内径(LVESD)在术后2周内、6个月、1年、2～3年较术前分别下降7.74 mm[95%CI(3.76,11.72),P<0.001],15.54 mm[95%CI(12.55,18.54),P<0.001],18.84 mm[95%CI(15.54,21.14),P<0.001]和21.02 mm[95%CI(17.67,24.37),P<0.001];左心室射血分数(LVEF)在术后2周内较术前下降7%[95%CI(1%,12%),P=0.013];术后6个月较术前上升9%[95%CI(-14%,-3%),P=0.002],术后1年较术前上升11%[95%CI(-22%,0%),P=0.041],术后2～3年较术前上升13%[95%CI(-21%,-4%),P=0.004],左心室短轴缩短率(LVFS)在术后2周内较术前下降0.05[95%CI(0.03,0.07),P<0.001],术后6个月较术前上升0.02[95%CI(0.00,0.04),P=0.055],术后1年较术前上升0.03[95%CI(0.00,0.06),P=0.035],术后2～3年较术前上升0.06[95%CI(0.02,0.011),P=0.008]。结论大左心室心脏瓣膜病患者心瓣膜置换术后LVEDD和LVESD持续下降,6个月内下降最明显,2～3年恢复至正常水平;LVEF及LVFS术后2周内降低,之后开始升高,6个月时高于术前水平,2～3年达到正常水平;心瓣膜置换术有利于大左心室心脏瓣膜病患者左心形态和收缩功�Objective To conduct a systematic review to evaluate preoperative and postoperative changes of echo- cardiography indexes which reflect left ventricular morphology and contractile function after heart valve replacement of patients with valvular heart disease with giant left ventricle. Methods We electronically searched CBMdisc, VIP database, Wanfang database, CNKI database, PubMed and ScienceDirect from time of establishment of each database to June 2012 to identify literatures addressing heart valve replacement for patients with valvular heart disease and giant left ventricle. Quality of included literatures was evaluated, and relevant data were extracted to conduct meta-analysis. Preoperative and postoperative changes of echocardiography indexes of patients undergoing heart valve replacement were compared. R2.15.2 software was used for statistical analysis. Results Twelve retrospective cohort studies were included in this study involving 833 patients. The quality of included literature was relatively high. Meta-analysis showed that left ventricular end-diastolicdiameter （LVEDD） at 2 weeks, 6 months, 1 year, 2 to 3 years postoperatively were reduced by 11.72 mmi95% CI （9.52, 13.92）, P 〈 0.001 ], 20.02 mm I95% CI （ 18.28, 21.76）, P 〈 0.0011, 22.48 mm I95% CI （ 19.55, 25.40）, P 〈 0.001 ] and 24.69 mm I95% CI （22.21, 27.18）, P 〈 0.001 ] respectively compared with preoperative value. Left ventricular end-systolic diameter （LVESD） at 2 weeks, 6 months, 1 year, 2 to 3 years postoperatively were reduced by 7.74 mm E 95% CI （3.76, 11.72）, P 〈 0.0011, 15.54 mm E95% CI （12.55, 18.54）, P 〈 0.0011, 18.84 mm E95% CI （15.54, 21.14）, P 〈 0.001 ] and 21.02 mm E95% CI （ 17.67, 24.37）, P 〈 0.001 ] respectively compared with preoperative value. Compared with preoperative value, left ventricular ejection fraction （LVEF） decreased by 7% at 2 weeks postoperatively [ 95% CI （1%, 12%）, P=0.013 ], increased by 9% at 6 months postoperatively L95% CI （-14%, -3%）, P=0.002]

关 键 词：大左心室 心脏瓣膜病 心瓣膜置换术 超声心动图 系统评价 META分析 

分 类 号：R654.2[医药卫生—外科学]