肥胖对小主动脉瓣人工瓣膜置入术后长期生存的影响  

Impact of obesity on long-term survival after aortic valve replacement with small prosthesis

作　　者：王彪[1] 杨洪阳[1] 吴树明[1] 张希全[1] 王涛[1] 庞昕焱[1] 

机构地区：[1]山东大学齐鲁医院心血管外科,济南250012

出　　处：《中华胸心血管外科杂志》2013年第7期414-418,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评估肥胖对于小主动脉瓣人工瓣膜（直径≤21mm）置换术后长期生存率的影响。方法1998年1月至2008年12月对307例首次接受小号主动脉瓣置换术生存时间超过1个月者进行长期随访。并根据身体质量指数（BMI）划分为3组：BMI〈24．0kg／m。为正常组（185例），BMI24．0～27．9ks／m。为超重组（94例），BMIi〉28ks／m。为肥胖组（28例）。分别在术后第3、6个月，第1、3、5、8年收集NHYA分级，有效瓣口面积指数（EOAI），左心室质量指数（LVMI），左心室射血分数（LVEF）等指标，了解各组中这些指标的变化及组间比较，分析肥胖是否与生存率有关；计算总体死亡率及3组各自死亡率并比较。结果经过单变量和多变量分析，并通过倾向得分调节，肥胖均为影响生存率的独立危险因子（HR：1．62；P=0．01）。长期随访中，肥胖组和超重组生存率较正常组低，而且术后NYHAIII／IV级患者所占比例偏高。3组中肥胖组和超重组EOAI偏小，LVMI偏高，均有统计学意义。但LVEF无明显变化。结论肥胖和术后长期生存率密切相关，肥胖和超重均可能降低术后的长期生存率。EOAI可能在其中发挥重要作用，提高EOAI会提高术后长期生存率，改善术后长期生存质量。Objeftive This study was designed to evaluate the effect of obesity on late survival after aortic valve replace ment（AVR） in patients with implantation of small aortic prosthesis（ size〈21 ）. Methods From January 1998 through De cember 2008, 307 patients in a single center in china underwent primary AVR with smaller prosthesis survive the 30 days of surgery. Patients were defined as normal if body mass index （BMI） 〈 24.0 kg/m2 , as overweight if BMI 24.0 27.9 kg/m2 , and as obesity if BMI〉28.0 kg/m2. Data of New York Heart Associatian（NYHA） Functional class, effective orifice area in dex （EOAI） ,left ventricular mass index（ LVMI）, left ventricular ejection fraction（LVEF） were got at the 3rd month（ M）, 6th M, 1st year（ Y）, 3rd Y, 5th Y, 8th Y after operation respectively. Results At multivariable analysis, obesity was independ ent factor of later mortality[ hazard ratio（HR） ： 1.62 ; P = 0. 01 ]. Obesity group and overweight group had poor survival（ P 〈 0. 001 ）and higher proportion of NYHA Function m/IV （P 〈0.01 ） in longterm compared to normal group. EOAI were lower and LVMI were higher in obesity group and overweight group, but LVEF have no significant difference. Conclusion Obesity is associated with increased late mortality after AVR in patients with implantation of small aortic prosthesis. Obesity and over weight may also affect the NYHA function in long term. EOAI should be improved where possible as it may reduce late mortality and improve life quality in such patients.

关 键 词：心脏瓣膜假体植入 主动脉瓣 肥胖 人体质量指数 

分 类 号：R654.2[医药卫生—外科学]