心脏人工生物瓣膜与机械瓣膜置换在育龄期妇女疗效和安全性评价  

Application of Biological Heart Valves (BHV) and Mechanical Heart Valves (MHV) in the Female Patients of Childbearing Age:a Matched Paired Study

作　　者：任鹏伟 梁怀民 张洪伟[3] 古君[3] 范康均 肖正华[3] 张尔永[3] 董力[3] 胡佳[3] 

机构地区：[1]四川大学华西医院临床流行病学与循证医学教研室,成都610041 [2]中国科学技术大学附属第一附医院心脏大血管外科,合肥230001 [3]四川大学华西医院心脏大血管外科,成都610041

出　　处：《四川大学学报（医学版）》2018年第2期231-234,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的观察比较心脏人工生物瓣膜与机械瓣膜在育龄期妇女(18~40岁)中的应用情况以及围术期、围产期和术后近中期疗效。方法回顾纳入2005年9月至2014年12月于四川大学华西医院行心脏人工生物瓣膜置换术并完成随访的33例育龄期[(25.2±7.1岁)]女性患者,按照1∶4比例纳入132例人工机械瓣膜植入患者匹配。随访其围术期、围产期和术后近中期(3~5年)临床结局。结果平均随访(5.8±3.6)年,两组患者术前基本情况、围术期和术后近中期临床结局无明显差异。17例生物瓣膜置换患者术后有孕产经历(pregnancy and birth experiences,PBE),术后(3.8±1.1)年共经历PBE 21次;60例机械瓣膜置换患者术后有PBE,术后(3.6±1.4)年共经历PBE 69次,两组患者孕产期和胎儿不良事件发生率无明显差异。此外,有PBE的17例生物瓣膜置换患者术后3年和5年心瓣膜置换相关不良事件发生率分别为5.9%和11.8%,而无PBE的16例生物瓣患者上述发生率分别为0%和5.9%,两组总体无病生存率(未发生心瓣膜相关不良事件的概率)差异无统计学意义(P=0.43)。结论育龄期女性选用人工生物瓣膜或机械瓣膜植入均能取得理想的近中期疗效,而选用生物瓣膜并未较植入机械瓣膜获得更佳的围产期结局。PBE可能不会增加生物瓣膜相关不良事件发生的风险。Objective To observe the efficacy and safety of biological heart valves （BHV） and mechanical heart valves （MHV） in childbearing age women （CAW） during the perinatal and short-moderate term postoperative （SMTP） periods. Methods There were 33 patients [（25. 2±7. 1） yr. ] undergoing BHV replacement from September 2009 to December 2014 had completely followed-up, whose data were retrospectively collected. A 1 ： 4 matching study was conducted, therefore there were 132 patients undergoing MHV were included. The collected date included the clinical outcomes in the perioperative, perinatal, and SMTP period event-free survival （EFS） was determined using the Kaplan-Meier method and compared using the log-rank test. Results The average follow-up time was （5.8±3.6） years, and the two groups had similar baseline . The clinical outcomes difference of perinatal and SMTP between the two groups were not significant. There were 17 patients in BHV group and 60 in MHV group with pregnancy and birth experiences （PBE）, which also showed no significant difference for adverse events both in the maternity and in the fetus. The rates of valve-related adverse events of BHV replacement patients with and without PBE were 5.9 % and 0 %at 3 years after the operation,and 11.8% and 5.9 % after 5 years. PBE was not identified as an adverse prognostic factor for EFS （P = 0. 43）. Conclusions Either artificial BHV or MHV replacement can achieve ideal SMTP effect in CAW. BHV seems not superior to MHV. Pregnancy and birth experience will not increase the risk of BHV relevant adverse events.

关 键 词：瓣膜置换 人工生物瓣膜 人工机械瓣膜 围产期结局 瓣膜相关不良事件 

分 类 号：R654.2[医药卫生—外科学]