重度主动脉瓣狭窄患者经导管主动脉瓣植入术后早期高血压影响因素的单中心回顾性队列研究  

Risk factors for early postoperative hypertension after transcatheter aortic valve implantation in patients with severe aortic stenosis:A retrospective cohort study in a single center

作　　者：尚基高 张培德[1] 王旭[2] 冯翔 李玄庶 张燕搏[1] 王巍[2] SHANG Jigao;ZHANG Peide;WANG Xu;FENG Xiang;LI Xuanshu;ZHANG Yanbo;WANG Wei(Department of Cardiac Intensive Care Unit,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China;Department of Structural Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院、国家心血管病中心、阜外医院、术后恢复中心,北京100037 [2]中国医学科学院北京协和医学院、国家心血管病中心、阜外医院、结构性心脏病中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2024年第12期1813-1819,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨重度主动脉瓣狭窄患者经导管主动脉瓣植入术(transcatheter aortic valve implantation,TAVI)后当日高血压事件的危险因素和潜在机制。方法回顾性收集2023年12月—2024年2月因重度主动脉瓣狭窄于阜外医院结构性心脏病中心接受TAVI患者的临床资料。根据术后当日收缩压峰值,将患者分为高血压组(≥140 mm Hg)和正常血压组(<140 mm Hg)。采用logistic回归模型分析TAVI术后当日高血压的危险因素。结果共纳入54例TAVI术后患者,高血压组41例,其中男18例、女23例,平均年龄(72.83±6.78)岁;正常血压组13例,其中男9例、女4例,平均年龄(70.00±7.57)岁。单因素分析发现,室间隔厚度[(13.71±1.98)mm vs.(12.23±1.59)mm,P=0.018]、术前左心室射血分数(left ventricular ejection fraction,LVEF)>55%[33(80.5%)vs.6(46.2%),P=0.040]、术后当日LVEF>55%[33(80.5%)vs.4(30.8%),P=0.003]差异有统计学意义。多因素logistic回归分析发现术后当日LVEF>55%[OR=10.173,95%CI(1.044,99.115),P=0.046]是TAVI术后当日高血压的独立危险因素。结论心肌收缩力主要参与了TAVI术后当日高血压的发生。本研究不仅可以提高我们对TAVI术后早期血流动力学变化的认识,还为TAVI术后早期高血压治疗方案的制定提供依据,以改善患者近远期预后。Objective To explore the risk factors and potential mechanisms of hypertension events on the same day after transcatheter aortic valve implantation(TAVI)in patients with severe aortic stenosis.Methods Clinical data of patients who underwent TAVI for severe aortic stenosis at Department of Structural Heart Disease,Fuwai Hospital from December 2023 to February 2024 were retrospectively collected.According to the peak systolic blood pressure on the same day after surgery,patients were divided into a hypertension group(≥140 mm Hg)and a normal blood pressure group(<140 mm Hg).Logistic regression model was used to analyze the risk factors for hypertension on the same day after TAVI.Results A total of 54 patients after TAVI were included,with 41 patients in the hypertension group,including 18 males and 23 females,with an average age of(72.83±6.78)years;13 patients in the normal blood pressure group,including 9 males and 4 females,with an average age of(70.00±7.57)years.Univariate analysis found that there were statistical differences in interventricular septal thickness[(13.71±1.98)mm vs.(12.23±1.59)mm,P=0.018],preoperative left ventricular ejection fraction(LVEF)>55%[33(80.5%)vs.6(46.2%),P=0.040],and postoperative same-day LVEF>55%[33(80.5%)vs.4(30.8%),P=0.003].Multivariate logistic regression analysis found that postoperative same-day LVEF>55%[OR=10.173,95%CI(1.044,99.115),P=0.046]was an independent risk factor for hypertension on the same day after TAVI.Conclusion Myocardial contractility mainly participates in the occurrence of hypertension on the same day after TAVI.This study can not only improve our understanding of early hemodynamic changes after TAVI,but also provide a basis for the formulation of early hypertension treatment plans after TAVI to improve the short-and long-term prognosis of patients.

关 键 词：经导管主动脉瓣植入术 重度主动脉瓣狭窄 术后高血压 危险因素 

分 类 号：R654.2[医药卫生—外科学]