两种术式治疗主动脉瓣病变伴升主动脉扩张的疗效分析  

Comparison of two surgical treatment for aortic valve diseases combined with ascending aortic dilatation

作　　者：朱江[1] 李卓东 谈梦伟[1] 唐昊[1] 徐志云[1] Zhu Jiang Li Zhuo-dong Tan Meng-wei Tang Hao Xu Zhi-yun(Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, Chin)

机构地区：[1]第二军医大学长海医院心血管外科,上海200433

出　　处：《中国体外循环杂志》2017年第3期153-158,共6页Chinese Journal of Extracorporeal Circulation

摘　　要：目的对比分析主动脉瓣病变合并升主动脉扩张的患者,在行主动脉瓣置换(AVR)的同时,实施升主动脉成形术或升主动脉置换术,探讨影响这两种手术方式治疗主动脉瓣病变合并升主动脉扩张的术后不良事件发生的危险因素。方法回顾性分析2009年1月至2015年12月于本院诊治的主动脉瓣病变合并升主动脉扩张的患者124例,根据不同手术方式分成两组,其中AVR联合升主动脉置换术组43例,AVR联合升主动脉成形术组81例,两组患者在性别、年龄、体重指数(BMI),心功能NYHA分级,主动脉瓣病变例数,升主动脉病变例数,术前左室舒张末期容积(LVEDV)及心脏射血分数(EF)的差异无统计学意义(P>0.05),比较两组患者术中、术后的相关临床参数及不良事件的发生情况,多因素logistics回归评估手术方式与不良事件发生的相关性。结果两组患者在术中置换的主动脉瓣类型,术后早期升主动脉直径,术后随访升主动脉直径上的差异无统计学意义(P>0.05)。两组患者的不良事件发生率分别为27.9%,12.3%,差异有统计学意义(P=0.05)。针对不良事件发生多因素Logistic回归分析显示:二叶式主动脉瓣(BAV)(P=0.015,OR=6.892,95%CI:1.452~32.724)、术前升主动脉直径增大(P<0.01,OR=3.087,95%CI:1.545~6.166)和术前LVEDV扩张(P=0.01,OR=1.011,95%CI:1.002~1.020)是不良事件发生的独立危险因素。结论虽然两组患者不良事件发生率不同,但手术方式不影响主动脉瓣病变合并升主动脉扩张患者术后不良事件的发生,而BAV、术前升主动脉直径增大和术前LVEDV是不良预后的独立预测因素。Objective To analyze risk factors for postoperative adverse events of patients with aortic valve diseases combined with ascending aortic dilatation,and to provide theoretical basis for clinical diagnosis and treatment of aortic valve diseases combined with ascending aortic dilatation.Methods One hundred and twenty-four patients with aortic valve diseases combined with ascending aortic dilatation were analyzed retrospectively,and all of them underwent aortic valve replacement （AVR） combined with ascending aortic replacement （or aortoplasty）.Patients were divided into observation group （22） and control group （102） according to the adverse events occurred in the follow-up period.Results Univariate analysis of prognostic factors showed statistically significances in gender,aortic valve,preoperative diameter of ascending aorta,preoperative left ventricular end diastolic volume （LVEDV） between the 2groups.Multiple regression analysis indicated that bicuspid aortic valve （BAV） （P = 0.015,OR = 6.892,95% CI：1.452-32.724）,longer preoperative diameter of ascending aorta （P〈0.01,OR = 3.087,95%CI：1.545-6.166）,larger preoperative LVEDV （P =0.01,OR = 3.087,95%CI：1.545-6.166） were risk factors of poor prognosis.Conclusion BAV,preoperative diameter of ascending aorta,larger preoperative LVEDV are independent predictors of poor prognosis in patients with aortic valve diseases combined with ascending aortic dilatation.

关 键 词：升主动脉扩张 主动脉 主动脉置换术 主动脉成形术 预后 

分 类 号：R654.2[医药卫生—外科学]