风湿性联合瓣膜病行左心瓣膜置换同期机械瓣三尖瓣置换术后早期与远期临床结果分析  

Analysis of early and long-term clinical Results after left Heart Valve Replacement and mechanical tricuspid Valve Replacement for rheumatic combined Valve Disease

作　　者：金星 刘曦琼 JIN Xing;LIU Xiqiong(Department of Cardiology,First Affiliated Hospital of Henan University of Science and Technology,Luoyang Henan 471000,China;Department of Psychiatry,Fifth People's Hospital of Luoyang,Luoyang Henan 471000,China)

机构地区：[1]河南科技大学第一附属医院心外科,河南洛阳471000 [2]洛阳市第五人民医院精神二十科,河南洛阳471000

出　　处：《临床研究》2023年第9期37-40,共4页Clinical Research

摘　　要：目的探究风湿性联合瓣膜病患者采用左心瓣膜置换同期机械瓣三尖瓣置换术后早期与远期临床效果。方法回顾性分析河南科技大学第一附属医院2020年3月至2022年6月收治的86例行左心瓣膜置换同期机械瓣三尖瓣置换术的风湿性联合瓣膜病患者临床资料,根据患者肺动脉收缩压(PASP)程度将其分为轻度组(PASP≤50mmHg,41例)和中重度组(PASP>50 mmHg,45例),了解患者术后住院期间、出院后出现的并发症情况,比较患者术前、术后心动图特征,比较轻度组和中重度组患者呼吸机使用时间及在重症监护室停留时间,观察观察患者在术后12个月后(远期)的瓣膜相关情况及存活率。结果经过回顾性分析发现,轻度组和中重度组术后并发症比较,差异无统计学意义(P>0.05)。术后3个月内患者病死率为9.30%(8/86),分析原因发现,因肺部感染引起患者出现多器官功能衰竭、低心排血量综合征、急性肾衰竭、呼吸异常骤停造成患者死亡的比例分别为25.00%(2/8)、37.50%(3/8)、25.00%(2/8)和12.50%(1/8)。手术后,患者的右心房内径、右心室内径、左心射血分数均较手术前有所恢复,差异有统计学意义(P<0.05)。中重度组患者呼吸机使用时间、重症监护室停留时间均长于轻度组,差异有统计学意义(P<0.05)。术后对余下的78例患者展开随访,在2022年10月至2023年6月随访期间发现有9例(11.54%)患者病死,分析原因发现,因反复心力衰竭、二次手术后并发脑出血、低心排血量综合征及脑栓塞而造成患者去世的占比分别为66.67%(6/9)、11.11%(1/9)、11.11%(1/9)、11.11%(1/9)。生存的69例患者随着随访时间的延长,其心功能均有所恢复,轻度组患者在术后1年、术后5年及术后10年的存活率分别为(92.05±4.58)%、(86.89±6.05)%和(78.00±8.31)%,中重度组患者分别为(90.89±5.00)%、(84.55±6.01)%、(75.01±7.58)%,两组存活率均比较高,但两组存活率比较,差异无统Objective To investigate the early and long-term clinical effects of left heart valve replacement and mechanical tricuspid valve replacement in patients with rheumatic combined valve disease.Method A retrospective analysis was conducted on the clinical data of 86 patients with rheumatic combined valve disease who underwent left heart valve replacement and mechanical tricuspid valve replacement at the First Affiliated Hospital of Henan University of Science and Technology from March 2020 to June 2022.According to the degree of pulmonary artery systolic pressure(PASP),the patients were divided into mild group(PASP≤50 mmHg,41 cases)and moderate to severe group(PASP>50 mmHg,45 cases).The complications during hospitalization and after discharge were understanded,the characteristics of preoperative and postoperative cardiogram were compared,the duration of mechanical ventilation and the length of intensive-care unit stay were compared between mild group and moderate-severe group.The valve related condition and survival rate were observed 12 months after operation.Results After retrospective analysis,it was found that there was no statistically significant difference in postoperative complications between the mild group and the moderate to severe group(P>0.05).The mortality rate of patients within 3 months after surgery was 9.30%(8/86).Analysis of the causes revealed that the mortality rate of patients with multiple organ failure(MOF),low cardiac output syndrome(LCO),acute renal failure(ARF)and abnormal respiratory arrest caused by pulmonary infection was 25.00%(2/8),37.50%(3/8),25.00%(2/8)and 12.50%(1/8)respectively.After surgery,the patient's right atrial diameter,right ventricular diameter,and left ventricular ejection fraction all recovered compared to before surgery,with statistically significant differences(P<0.05).The use time of the ventilator and the stay time in the intensive care unit of patients in the moderate to severe group were longer than those in the mild group,and the difference was statistically si

关 键 词：风湿性联合瓣膜病 左心瓣膜置换术 机械瓣三尖瓣置换术 并发症情况 生存情况 

分 类 号：R541[医药卫生—心血管疾病]