心功能分级和术前肺动脉高压对风湿性心脏病患者心脏瓣膜置换术后并发症的影响  

Influences of cardiac function grading and pulmonary arterial hypertension on the postoperative complications of valve replacement surgery in patients with rheumatic heart disease

作　　者：房大广[1] 冯增斌[1] 崔春燕[1] 陈永良[1] FANG Da-guang;FENG Zeng-bin;CUI Chun-yan;CHEN Yong-liang(Department of Cardiac Surgery,Affiliated Hospital of Chengde Medical University,Chengde,Hebei 067000,China)

机构地区：[1]承德医学院附属医院心脏外科,河北承德067000

出　　处：《中国临床研究》2020年第5期630-632,637,共4页Chinese Journal of Clinical Research

基　　金：河北省卫生厅医学科学研究重点项目(20170528)。

摘　　要：目的分析心功能分级和术前肺动脉高压(PAH)对风湿性心脏病(RHD)行心脏瓣膜置换术患者术后并发症的影响。方法采用回顾性研究,收集2016年3月至2019年3月收治200例RHD患者行心脏瓣膜置换术治疗的临床资料,先经Pearson相关性分析筛选可能影响术后并发症的危险因素,再经多因素Logistic回归分析筛出影响术后并发症的独立危险因素。结果200例患者中,发生术后并发症16例(8.00%),包括术后脑血管意外1例(0.50%),肺部感染3例(1.50%),低心排出量4例(2.00%),肾功能不全3例(1.50%),死亡5例(2.50%)。单因素分析发现,年龄、美国纽约心脏病学会(NYHA)心功能分级、三尖瓣关闭不全、糖尿病、体外循环时间、主动脉阻断时间、PAH与RHD患者术后并发症的发生密切相关(P<0.05,P<0.01)。多因素Logistic回归分析发现,糖尿病、NYHA心功能分级、体外循环时间和PAH均是RHD患者瓣膜置换术后发生并发症的独立影响因素(P<0.05,P<0.01)。结论伴有糖尿病、PAH、高NYHA心功能分级(Ⅲ~Ⅳ级)、体外循环时间延长(>180 min)是RHD行瓣膜置换术后发生并发症的独立危险因素。Objective To analyze the impacts of cardiac function classification and pulmonary arterial hypertension(PAH) on the postoperative complications of patients with rheumatic heart disease(RHD) underwent valve replacement operation.Methods A retrospective study was conducted on the clinical data of 200 patients with RHD receiving valve replacement from March 2016 to March 2019.After screening the possible risk factors of postoperative complications by Pearson correlation analysis,multivariate Logistic regression analysis was used to analyze the independent risk factors of complications after valve replacement operation.Results There were 16 patients(8.00%) with postoperative complications,including 1 case(0.50%) of cerebrovascular accident,3 cases(1.50%) of pulmonary infection,4 cases(2.00%) of low cardiac output,3 cases(1.50%) of renal insufficiency and 5 cases(2.50%) of deaths.Monofactor analysis showed that age,New York Heart Association(NYHA) classification of cardiac function,tricuspid insufficiency,diabetes mellitus,cardiopulmonary bypass time,aortic cross clamp time and PAH were closely related to the occurrence of postoperative complications in RHD patients(P<0.05,P<0.01).Multivariate Logistic regression analysis showed that diabetes mellitus,NYHA classification,cardiopulmonary bypass time and PAH were the independent influencing factors of complications after valve replacement in RHD patients(P<0.05,P<0.01).Conclusion Diabetes mellitus,PAH,high NYHA classification(Ⅲ~Ⅳ) and prolonged cardiopulmonary bypass(>180 min) are the independent risk factors for complications after valve replacement surgery in patients with RHD.

关 键 词：风湿性心脏病 心脏瓣膜置换术 肺动脉高压 并发症 危险因素 

分 类 号：R541.2[医药卫生—心血管疾病]