大左心室心脏瓣膜病心瓣膜置换术后疗效及危险因素分析  

Clinical Outcomes and Risk Factor Analysis of Patients with Valvular Heart Disease and Giant Left Ventricle Undergoing Heart Valve Replacement

作　　者：王寅[1] 张平[1] 董念国[1] 史嘉玮[1] 

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

出　　处：《中国胸心血管外科临床杂志》2014年第4期440-446,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技支撑计划项目(2011BAI11B19)~~

摘　　要：目的探讨大左心室心脏瓣膜病心瓣膜置换术后疗效及危险因素,以提高手术疗效。方法回顾性分析2009年1月至2012年12月期间华中科技大学同济医学院附属协和医院144例大左心室心脏瓣膜病患者行心瓣膜置换术的临床资料,其中男116例、女28例,年龄15~69（44.9±11.9）岁;病程1个月~40年,平均病程（57.8±98.3）个月。风湿性心脏瓣膜病92例,退行性心脏瓣膜病28例,先天性心脏瓣膜病15例,感染性心内膜炎9例。对存活出院的137例患者进行随访,用t检验、卡方检验或Fisher′s精确概率法及logistic回归分析,探讨大左心室心脏瓣膜病患者行心瓣膜置换术后早期住院死亡、主要并发症发生及远期死亡的危险因素。采用寿命表生存率法计算术后远期生存率,并绘制生存曲线。结果术后早期主要并发症为低心排血量综合征19例（13.2%）,室性心律失常56例（38.9%）,人工瓣膜瓣周漏7例（4.9%）,胸腔积液33例（22.9%）,心包积液8例（5.6%）,肝功能不全23例（16.0%）,肾功能不全5例（3.5%）。术后早期住院死亡7例,死亡率4.9%。Logistic单因素分析显示：年龄〉50岁、风湿性心脏瓣膜病、术前心功能分级（NYHA）高（Ⅲ级或Ⅳ级）、病程长、术前左心功能低下[左心室射血分数（LVEF）〈40%]、双瓣膜置换术、合并其他心脏手术、体外循环及主动脉阻断时间长、术后低心排血量综合征和术后室性心律失常是大左心室心脏瓣膜病患者心瓣膜置换术后早期住院死亡的危险因素（P〈0.05）;Logistic多因素回归分析结果显示：年龄〉50岁、病程时间长、术前心功能分级（NYHA）高（Ⅳ级）、术前左心功能低下（LVEF〈40%）、双瓣膜置换术、体外循环时间长是术后早期住院死亡的危险因素（P〈0.05）。Logistic多因素回归分析结果显示：术前心功能分级（NYHA）高（Ⅲ级或Ⅳ级）、合并其他心脏手术、术前左心�Objective To investigate clinical outcomes and risk factors of patients with valvular heart disease （VHD） and giant left ventricle undergoing heart valve replacement （HVR）. Methods Clinical data of 144 VHD patients with giant left ventricle who underwent HVR in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2009 to December 2012 were retrospectively analyzed. There were 116 male and 28 female patients with their age of 15-69 （44.9 ± 11.9 ）years and disease duration of 57.8 ± 98.3 months （range, 1 month to 40 years ）. There were 92 patients with rheumatic VHD, 28 patients with degenerative VHD, 15 patients with congenital VHD, and 9 patients with infective endocarditis. A total of 137 patients who were discharged alive were followed up. Risk factors of postoperative mortality, morbidity and late death of VHD patients with giant left ventricle undergoing HVR were analyzed with t-test, chi-square test or Fisher＇s exact test, and logistic regression analysis. The life-table method was used to calculate long-term survival rate and draw the survival curve. Results Major postoperative complications included low cardiac output syndrome （LCOS） in 19 patients （13.2%）, ventricular arrhythmias in 56 patients （38.9%）, prosthetic paravalvular leaks in 7 patients （4.9%）, pleural effusion in 33 patients （22.9%）, pericardial effusion in 8 patients （5.6%）, liver failure in 23 patients （ 16.0% ）, and renal failure in 5 patients （3.5%）. Seven patients （4.9%） died postoperatively. Logistic univariate analysis showed that advanced-age （ 〉 50 years ）, rheumatic VHD, higher preoperative NYHA class （ Ill or IV ）, long disease duration, poor preoperative left ventricular function [ left ventricular ejection fraction （LVEF） 〈 40% J, double valve replace- ment （DVR）, other concomitant intracardiac procedures, prolonged cardiopulmonary bypass （ CPB ） time and aortic cross- clamping time, postoperative LCOS and

关 键 词：心脏瓣膜病 大左心室 心瓣膜置换术 危险因素 疗效 

分 类 号：R654.2[医药卫生—外科学]