二尖瓣置换术中术后左心室后壁破裂的影响因素  

Influencing factors of left ventricular posterior wall rupture during and after mitral valve replacement

作　　者：何剑成[1] 邢朝阳[1] 郑涛[1] 赵帆 姚蓉[2] HE Jiancheng;XING Chaoyang;ZHENG Tao;ZHAO Fan;YAO Rong(Department of ICV,the First People′s Hospital of Guangyuan,Guang yuan,Sichuan 628000;Emergency Department,West China Hospital,Sichuan University,Chengdu 610000)

机构地区：[1]广元市第一人民医院重症医学科,四川广元628000 [2]四川大学华西医院急诊科,成都610000

出　　处：《郑州大学学报（医学版）》2019年第5期693-696,共4页Journal of Zhengzhou University(Medical Sciences)

基　　金：四川省卫生和计划生育委员会科研课题(17PJ015)

摘　　要：目的:分析二尖瓣置换(MVR)术中术后左心室后壁破裂的影响因素。方法:收集接受MVR的520例患者的资料,其中10例发生左心室后壁破裂。采用Poisson回归筛选MVR术中术后左心室后壁破裂的影响因素。结果:520例中,3例于术中、7例于术后发生左心室后壁破裂,发生率为1.92%(10/520);1例术中发生早期破裂,经体外循环心室内修补存活;另9例均于院内死亡。Poisson回归分析结果显示,年龄、贫血、瓣膜假体选择不当、风湿性心脏病史、NYHA心功能分级Ⅲ~Ⅳ级、LVEF<50%、LVEDD>80 mm、左室后壁厚度≥10 mm为MVR术中术后发生左心室后壁破裂的危险因素,IRR(95%CI)分别为1.234(1.038~1.466)、1.514(1.019~2.250)、1.412(1.138~1.752)、2.192(1.348~3.565)、1.508(1.225~1.857)、1.477(1.212~1.800)、1.322(1.164~1.501)、1.565(1.023~2.395);而体外循环时间<140 min、不使用正性肌力药物为保护因素,IRR(95%CI)分别为0.667(0.529~0.841)、0.662(0.516~0.850)。结论:MVR术前应进行风险评估,选择合适瓣膜假体,并调整患者心功能至最佳状态后手术。Aim:To analyze the influencing factors of left ventricular posterior wall rupture during and after mitral valve replacement(MVR).Methods:The data of 520 patients with MVR were collected,and left ventricular posterior wall rupture occured in 10 patients.Poisson regression was used to explore the affecting factors of left ventricular posterior wall rupture during and after MVR.Results:Among the 520 patients,3 patients had left ventricular posterior wall rupture during operation,7 patients had rupture after operation,and the incidence was 1.92%(10/520);1 case had early rupture during operation,and survived after intraventricular repair under cardiopulmonary bypass;the other 9 cases died in hospital.Poisson regression analysis showed that age,anemia,improper selection of valvular prosthesis,history of rheumatic heart disease,NYHAⅢ+Ⅳ,LVEF<50%,LVEDD>80 mm,left ventricular posterior wall thickness≥10 mm were the risk factors,IRR(95%CI)were 1.234(1.038-1.466),1.514(1.019-2.250),1.412(1.138-1.752),2.192(1.348-3.565),1.508(1.225-1.857),1.477(1.212-1.800),1.322(1.164-1.501),1.565(1.023-2.395),respectively;the extracorporeal circulation time<140 min,no positive inotropic drugs were the protective factors,IRR(95%CI)were 0.667(0.529-0.841),0.662(0.516-0.850).Conclusion:Risk assessment should be conducted,proper valvular prosthesis should be chosen,and the patient should be adjusted to the best condition for surgery before MVR.

关 键 词：二尖瓣置换术 左心室后壁破裂 

分 类 号：R654.2[医药卫生—外科学]