二尖瓣置换术治疗风湿性心脏病的安全性及与心功能的相关性研究  

Safety of mitral valve replacement in the treatment of rheumatic heart disease and its correlation with cardiac function

作　　者：白和平[1] 张珍[1] BAI Heping;ZHANG Zhen(Department of Cardiothoracic Surgery,Yulin No.2 Hospital,Yan'an 719000,China)

机构地区：[1]榆林市第二医院胸心外科,陕西榆林719000

出　　处：《延安大学学报（医学科学版）》2022年第4期78-81,92,共5页Journal of Yan'an University:Medical Science Edition

基　　金：陕西省榆林市科技计划项目(YF-2020-056)。

摘　　要：目的探究二尖瓣置换术治疗风湿性心脏病(rheumatic heart disease,RHD)的安全性及与患者心功能的相关性。方法选取2018年1月至2022年4月榆林市第二医院和西安交通大学第一附属医院收治的170例RHD患者的临床资料,根据是否发生术后并发症将RHD患者分为并发症组和对照组。通过单因素分析及多因素Logistic回归比较并发症组和对照组患者的相关资料,分析影响RHD患者术后并发症发生的危险因素。使用ROC曲线分析心功能指标对RHD患者术后并发症的预测价值。结果149例RHD患者中,15例发生并发症,并发症发生率10.07%。对比两组患者的病程、心房纤颤发生率、左心室舒张末内径(left ventricular end-diastolic dimension,LVEDD)、左心室质量指数(left ventricular mass index,LVMI),并发症组均明显高于对照组,差异有统计学意义(P<0.05)。病程、心房纤颤、LVEDD、LVMI均为RHD患者二尖瓣置换术后并发症发生的独立危险因素(P<0.05)。LVEDD和LVMI对RHD患者术后并发症发生均具有较好的预测价值。结论RHD患者二尖瓣置换术后的并发症发生风险较高,其中病程长、合并有心房纤颤、LVEDD和LVMI较高的患者为术后并发症发生的高风险人群。Objective To study the safety of mitral valve replacement in the treatment of rheumatic heart disease(RHD)and its correlation with cardiac function.Methods The clinical data of 170 RHD patients admitted to the Yulin No.2 Hospital and the First Affiliated Hospital of Xi’an Jiaotong University from January 2018 to April 2022 were selected and divide into complication group and control group according to whether there are postoperative complications.The data of patients in the complication group and the control group were compared by univariate analysis and multivariate logistic regression to analyze the risk factors of postoperative complications in RHD patients.ROC curve was used to analyze the predictive value of cardiac function indicators for postoperative complications of RHD patients.Results Among 149 RHD patients,15 patients had complications,and the complication rate was 10.07%.The course of disease,incidence of atrial fibrillation,left ventricular end-diastolic dimension(LVEDD)and left ventricular mass index(LVMI)in the complication group were significantly higher than those in the control group(P<0.05).The course of disease,atrial fibrillation,LVEDD and LVMI were all independent risk factors for complications after mitral valve replacement in RHD patients(P<0.05).LVEDD and LVMI have good predictive value for postoperative complications of RHD patients.Conclusion Patients with RHD have a higher risk of complications after mitral valve replacement,among which patients with long course of disease,atrial fibrillation,higher LVEDD and LVMI are high-risk groups.

关 键 词：二尖瓣置换术 风湿性心脏病 安全性 并发症 心功能 

分 类 号：R654.2[医药卫生—外科学]