风湿性心脏病患者术前情况对换瓣术后发生慢性心功能不全的预测作用  

Predictive effect of pre-operative clinical characteristics on chronic heart failure after valve replacement in patients with rheumatic heart disease

作　　者：何勇[1] 刘光强[1] 李中杰[1] 陈冲[1] 谢学弟 黄创业[1] HE Yong;LIU Guang-qiang;LI Zhong-jie;CHEN Chong;XIE Xue-di;HUANG Chuang-ye(Department of Cardiovascular Surgery,Gaozhou People′s Hospital,Gaozhou,Guangdong 525200,China)

机构地区：[1]高州市人民医院心外科

出　　处：《岭南心血管病杂志》2019年第5期552-555,共4页South China Journal of Cardiovascular Diseases

基　　金：广东省医学科学技术研究基金项目（项目编号：A2018475）

摘　　要：目的分析风湿性心脏病患者术前情况对换瓣术后发生慢性心功能不全的预测因子。方法选取2014年7月至2018年1月在高州市人民医院确诊为风湿性心脏病并接受瓣膜置换术的343例患者作为研究对象进行回顾性研究,根据术后6个月患者的心功能状态,将诊断为慢性心功能不全的41例患者纳入心力衰竭组,而其他302例无慢性心功能不全的患者纳入对照组。收集两组患者的术前临床特征,进行单因素和多因素分析。结果两组患者术前临床特征比较,病程、并发冠状动脉粥样硬化性心脏病(冠心病)、左心室射血分数(left ventricular ejection fraction,LVEF)、心胸比、纽约心脏协会(New York Heart Association,NYHA)心功能分级、左心房血栓、肺动脉高压和左心房内径,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,病程≥10年、并发冠心病、LVEF≤50%、NYHA心功能Ⅲ~Ⅳ级、肺动脉高压和左心房内径≥60mm是风湿性心脏病患者换瓣术后发生慢性心功能不全的独立危险因素(P<0.05)。结论风湿性心脏病患者换瓣术后发生慢性心功能不全的影响因素较多,术前的预测因素包括病程、并发冠心病、LVEF、NYHA心功能分级、肺动脉高压和左心房内径。Objectives To analyze the predictive factors of pre-operative clinical characteristics for chromic heart failure after valve replacement in patients with rheumatic heart disease.Methods A total of 343 patients with rheumatic heart disease and valve replacement from July 2014 to January 2018 in Gaozhou People′s Hospital were recruited to perform the retrospective study.Based on patient′s heart function six months after operation,41 patients with chronic heart failure were involved in heart failure group,and the other 302 patients without chronic heart failure were assigned into control group.Patients′ pre-operative clinical characteristics were collected,and univariate and multivariate analysis were performed.Results In the comparison of pre-operative clinical characteristics between the two groups,significant differences in course of disease,combination with coronary heart disease,left ventricular ejection fraction(LVEF), cardio-thoracic proportion,New York Heart Association(NYHA)heart function classification,left atrial thrombus, pulmonary arterial hypertension and left atrial diameter were observed(P<0.05).According to multivariate Logistic regression analysis,the course of disease≥10 years,combination with coronary heart disease,LVEF≤50%,NYHA class Ⅲ-Ⅳ,pulmonary arterial hyphenation and left atrial diameter ≥60 mm were independent risk factors for chronic heart failure after valve replacement in patients with rheumatic heart disease.Conclusions There are multiple risk factors in chronic heart failure after valve replacement in patients with rheumatic heart disease and pre-operative prediction factors include the course of disease,combination of coronary heart disease,LVEF,NYHA heart function classification,pulmonary arterial hyphenation and left atrial diameter.

关 键 词：风湿性心脏病 瓣膜置换术 临床特征 心功能不全 

分 类 号：R541.2[医药卫生—心血管疾病]