合并反常低跨瓣压差及低心搏量主动脉瓣狭窄患者行主动脉瓣置换术临床预后的研究  

Impact of stroke volume and gradient on the clinical outcome of patients with aortic stenosis who underwent aortic valve replacement

作　　者：范兴例 王崇[1] 张加俊 薛清[1] 张冠鑫[1] 徐志云[1] 韩林[1] 

机构地区：[1]第二军医大学附属长海医院胸心外科,上海200433

出　　处：《国际心血管病杂志》2015年第3期202-206,共5页International Journal of Cardiovascular Disease

摘　　要：目的:探讨合并反常低跨瓣压差及低心搏量的主动脉瓣狭窄患者的手术预后情况。方法:入选2004年1月1日至2010年12月31日期间于上海长海医院胸心外科就诊的188例单纯性主动脉瓣重度狭窄的患者(瓣口面积≤1 cm2,左心室射血分数≥50%)。定义每搏输出量指数(stroke volume index,SVi)<35 mL/m2为低每搏量(low-flow,LF),SVi≥35 mL/m2为正常每搏量(normal-flow,NF);平均主动脉瓣跨瓣压差(mean gradient,MG)<40 mmHg为低跨瓣压差(low-gradient,LG),MG≥40 mmHg为高跨瓣压差(high-gradient,HG),据此将患者分为4组:NF/HG(n=59)、NF/LG(n=30)、LF/HG(n=80)和LF/LG(n=19)。收集患者一般临床资料和心脏超声数据,随访内容包括患者在院死亡情况及随访期总体生存情况。利用Logistic回归分析患者院内死亡的危险因素,Cox回归分析影响患者生存时间的危险因素,绘制KaplanMeier生存曲线。结果:患者平均随访时间为(59±32)个月,在院死亡情况为NF/HG组1例(1.7%),NF/LG组2例(6.7%),LF/HG组10例(12.5%),LF/LG组2例(10.5%)。随访期内各组总体生存率为NF/HG组72%,NF/LG组92%,LF/HG组55%,LF/LG组84%(P=0.025)。Logistic回归分析显示心房颤动、同期冠状动脉搭桥术、心指数和主动脉瓣二叶畸形是院内死亡的危险因素(P<0.05)。Cox回归生存分析显示,心指数、瓣膜血管性阻抗、体外循环时间、心房颤动、主动脉瓣二叶畸形以及同期冠状动脉搭桥术是影响远期生存率的因素(P<0.05)。结论:LF/LG主动脉瓣狭窄患者手术短期预后比NF/HG组和NF/LG组差,与LF/HG组预后相当;但LF/LG主动脉瓣狭窄患者远期预后优于NF/HG组和LF/HG组,比NF/LG组差。Objective：To estimate the impact of stroke volume and gradient on the clinical outcome of patients with aortic stenosis who underwent aortic valve replacement. Methods：A total of 188 consecutive patients with severe aortic stenosis[aortic valve area（AVA）≤1cm^2,left ventricular eject fraction（LVEF）≥50%]from January 1,2004 to December 31,2010 were retrospectively studied.The clinical and echocardiographic data were collected.According to stroke volume index（SVi）,low flow（LF,SVi35 mL/m2）and normal flow（NF,SVi≥35 mL/m2）were defined,and according to transvalvular pressure gradient,low gradient（LG,gradient40 mmHg）and high gradient（HG,gradient≥40 mmHg）were also defined.Based on the above classification,patients were divided into four groups：NF/HG（n=59）,NF/LG（n=30）,LF/HG（n=80）and LF/LG（n=19）.In-hospital mortality and overall survival were followed up.The risk factors of in-hospital mortality and overall survival were estimated by Logistic regression analysis and Cox regression analysis. Results：The mean follow-up time was（59±32）months.The in-hospital mortality of four groups was 1.7% for NF/HG,6.7% for NF/LG,12.5% for LF/HG and 10.5% for LF/LG.The overall survival rates among the four groups were 72%for NF/HG,92% for NF/LG,55% for LF/HG and 84% for LF/LG.Artrial fibrillation,concomitant coronary artery bypass graft,cardiac index and bicuspid aortic valve were the independent predictors for in-hospital mortality,and cardiac index,valvulo-arterial impedance,time of cardiopulmonary bypass,artrial fibrillation,bicuspid aortic valve and concomitant coronary artery bypass graft were the independent factors for overall survival. Conclusions：The in-hospital outcome of LF/LG is worse than NF/HG and NF/LG,but similar to LF/HG.For overall outcome,LF/LG is better than NF/HG and LF/HG,but worse than NF/LG.

关 键 词：每搏输出量 跨瓣压差 瓣膜血管性阻抗 

分 类 号：R654.2[医药卫生—外科学]