经导管三尖瓣介入术后肺部并发症的初次探索及康复建议:前瞻性队列研究  

First exploration of postoperative pulmonary complications after transcatheter tricuspid valve replacement and recommendations for rehabilitation:A prospective cohort study

作　　者：王渝强 石峻[1] 刘路路[1] 罗泽汝心 张凤梅 郭应强[1] 喻鹏铭[2,3] WANG Yuqiang;SHI Jun;LIU Lulu;LUO Zeruxin;ZHANG Fengmei;GUO Yingqiang;YU Pengming(Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Rehabilitation Medicine Center,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Key Laboratory of Rehabilitation Medicine in Sichuan Province,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院心脏大血管外科,成都610041 [2]四川大学华西医院康复医学中心,成都610041 [3]四川省康复医学重点实验室,成都610041

出　　处：《中国胸心血管外科临床杂志》2022年第8期963-970,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的研究经导管三尖瓣介入术后肺部并发症(postoperative pulmonary complications,PPCs)的发病情况。方法2020年10月11日—2021年3月1日四川大学华西医院招募了19例被诊断为重度及以上三尖瓣反流的患者,使用LuX-valve进行干预。根据是否出现PPCs将患者分为PPCs组与non-PPCs组,比较两组患者三尖瓣介入术后PPCs发生情况。结果在数据库登记的19例被诊断为重度及以上三尖瓣反流的患者中,17例符合纳入标准,其中女15例、男2例,平均年龄(68.4±8.0)岁。术后有9例(52.9%)患者出现了PPCs。出院时与non-PPCs组患者相比,PPCs组患者术后住院时间[11.0(10.0,17.0)d vs.7.5(7.0,8.0)d,P=0.01]、重症监护室停留时间[72.0(45.5,95.0)h vs.20.5(16.0,22.8)h,P<0.01]更长,住院费用[74.3(65.9,98.3)千元vs.52.6(44.2,57.4)千元,P<0.01]更高。随访30 d时发现与non-PPCs组患者相比,PPCs组患者的纽约心脏协会心功能分级≥Ⅲ级比例(66.7%vs.12.5%,P<0.01)更高,六分钟步行距离[(170.2±169.3)m vs.(377.9±80.5)m,P<0.01]更短,堪萨斯城心肌病调查问卷心力衰竭评分(40.9±31.2 vs.80.4±5.8,P<0.01)更差。结论在接受经导管三尖瓣介入治疗的患者中,PPCs很常见,严重影响患者心功能、运动功能和生活质量恢复。应对PPCs高风险人群进行积极主动的术前干预以及术后尽早康复管理。Objective To investigate the morbidity of postoperative pulmonary complications(PPCs)in patients after transcatheter tricuspid valve replacement(TTVR).Methods A prospective cohort study enrolled 19 patients who were diagnosed with severe or greater tricuspid regurgitation in West China Hospital from October 11,2020 to March 1,2021,and would receive TTVR using LuX-valve for valve replacement.The patients were divided into a PPCs group and a non-PPCs group according to the presence of PPCs.The incidence of PPCs after tricuspid valve intervention between the two groups was compared.Results Of 19 patients diagnosed with severe or greater tricuspid regurgitation registered in the database,17 met the inclusion criteria,including 15 females and 2 males,with a mean age of 68.4±8.0 years.PPCs occurred in 9 of 17(52.9%)patients.At discharge,compared with the non-PPCs group,the PPCs group had a longer postoperative hospital stay[11.0(10.0,17.0)d vs.7.5(7.0,8.0)d,P=0.01],longer ICU stay[72.0(45.5,95.0)h vs.20.5(16.0,22.8)h,P<0.01],and more hospital cost[74.3(65.9,98.3)thousand yuan vs.52.6(44.2,57.4)thousand yuan,P<0.01].At 30 days of follow-up,the PPCs group was found that the rate of New York Heart Association cardiac function≥classⅢ(66.7%vs.12.5%,P<0.01)was higher,the six-minute walk distance(170.2±169.3 m vs.377.9±80.5 m,P<0.01)was shorter and Kansas City Cardiomyopathy Questionnaire heart failure score(40.9±31.2 vs.80.4±5.8,P<0.01)was less than those of the non-PPCs group.Conclusion PPCs are common in the patients undergoing TTVR and severely affect patients'cardiac function,exercise function and quality-of-life recovery.Proactive preoperative intervention as well as early postoperative rehabilitation management should be provided to those at high risk of PPCs.

关 键 词：经导管三尖瓣介入术 术后肺部并发症 三尖瓣反流 预康复 前瞻性队列研究 

分 类 号：R542.53[医药卫生—心血管疾病]