自体心包片预防性三尖瓣成形术远期随访结果——832例风湿性心脏病患者倾向性匹配分析  

Long-term outcomes of prophylactic autologous pericardium tricuspid annuloplasty:propensity score matching of 832 patients with rheumatic heart disease

作　　者：张建[1] 梁贵友[1] 刘达兴[1] 任彦[1] 周浩[1] 彭格红[2] 陶文鸿[2] ZHANG Jian;LIANG Guiyou;LIU Daxing;REN Yan;ZHOU Hao;PENG Gehong;TAO Wenhong(Department of Cardiovascular Surgery,Affiliated Hospital of Zunyi Medical College,Zunyi 563003,Chin)

机构地区：[1]遵义医学院附属医院心血管外科,贵州563003 [2]遵义医学院附属医院超声科,贵州563003

出　　处：《实用医学杂志》2018年第9期1476-1480,共5页The Journal of Practical Medicine

基　　金：贵州省科技合作计划项目(编号:黔科合LH字[2015]7500号)

摘　　要：目的探讨风湿性心脏病同期自体心包片预防性三尖瓣成形术(TVA)的安全性和随访结果。方法风湿性心脏病手术患者832例,其中预防性TVA 146例(观察组);未行TVA 434例(对照组A);治疗性TVA 252例(对照组B)。应用倾向性评分及生存分析评价预防性TVA术后围手术期的安全性、功能性三尖瓣反流(FTR)进展、心功能不全(CHF)及主要不良心脑血管事件(MACCE)发生率的随访结果。结果成功匹配192例,观察组与各对照组围手术期并发症对比差异无显著性(P>0.05);随访结果:观察组FTR进展率显著低于对照组A(P=0.005)和对照组B(P=0.032),而CHF和MACCE事件发生率与各对照组对比差异无显著性(P>0.05)。结论自体心包片预防性TVA术,不增加手术费用、围手术期并发症及病死率,可有效改善术后FTR复发或进展。Objective To investigate the safety and long-term outcomes of prophylactic autologous pericar-dium tricuspid valve annuloplasty（TVA）in patients with rheumatic heart disease（RHD）. Methods A total of832 patients with RHD were enrolled in this study,including 146 patients with mild FTR but without TVA（obser-vation group）;434 patients with mild FTR underwent TVA（control group A）and 434 patients with moderate orsevere FTR underwent TVA（control group B）. Propensity score and survival analysis were used to evaluate periop-erative safety,FTR progression,CHF and MACCE incidence after prophylactic TVA. Results A total of 192 patients were successfully matched. There was no significant difference in the perioperative complications betweenthe observation group and the control groups（P〈0.05）. The progression rate of FTR in the observation group wassignificantly lower than that in the control groups（P = 0.005 0.032）. There was no significant difference inthe incidence of CHF and MACCE events between the observation group and the control groups（P〉0.05）.Conclusions The treatment strategy of prophylactic autologous pericardium TVA at the time of left heart valvesurgery for patients with RHD doesn′t increase operation costs,perioperative complications and mortality,buteffectively prevent postoperative FTR recurrence or progression.

关 键 词：风湿性心脏病 三尖瓣成形术 随访结果 

分 类 号：R654.2[医药卫生—外科学]