后天性心脏瓣膜病患者术后心脏康复效果、血管内皮功能的变化及预后影响因素分析  

Analysis of postoperative cardiac rehabilitation outcomes,changes in endothelial function,and prognostic factors in patients with acquired heart valve disease

作　　者：任青青 蒋东生[1] 刘昊轶 REN Qing-qing;JIANG Dong-sheng;LIU Hao-yi(Department of Rehabilitation Medicine,Fuyang People's Hospital,Fuyang Anhui 236000,China)

机构地区：[1]阜阳市人民医院康复医学科,安徽阜阳236000

出　　处：《临床和实验医学杂志》2025年第3期273-276,共4页Journal of Clinical and Experimental Medicine

基　　金：2021年度国家骨科与运动康复临床医学研究中心创新基金资助项目(编号:2021-NCRC-CXJJ-PY-35)。

摘　　要：目的分析后天性心脏瓣膜病患者术后心脏康复效果、血管内皮功能的变化及预后影响因素分析。方法回顾性选取2022年2月1日至2024年2月1日阜阳市人民医院收治的80例后天性心脏瓣膜病患者为研究对象。比较研究对象术前1 d及术后7 d心功能指标[左室射血分数(LVEF)、心脏指数(CI)]、血管内皮功能指标[血管内皮生长因子(VEGF)、内皮素-1(ET-1)]变化情况。所有研究对象均给予心脏瓣膜置换术,依据术后随访6个月是否再次手术或死亡分为预后不良组、预后良好组,分别为33、47例,对影响后天性心脏瓣膜病患者预后的因素进行单因素及多因素分析。结果术后7 d的LVEF、CI水平分别为(53.12±4.01)%、(2.63±0.83)L/(min·m^(2)),均高于术前1 d[(48.87±3.48)%、(2.07±0.41)L/(min·m^(2))],差异均有统计学意义(P<0.05)。术后7 d VEGF、ET-1水平分别为(253.16±23.15)pg/L、(45.15±5.62)ng/L,均低于术前1 d[(517.42±46.27)pg/L、(81.39±10.08)ng/L],差异均有统计学意义(P<0.05)。单因素分析显示,预后不良组术前1 d的LVEF、CI、VEGF、ET-1表达水平与预后良好组比较,差异均有统计学意义(P<0.05)。多因素回归分析显示,LVEF(OR=0.530,95%CI:0.302~0.931)、CI(OR=0.585,95%CI:0.377~0.907)是后天性心脏瓣膜病患者预后不良保护因素,VEGF(OR=1.521,95%CI:1.116~2.072)、ET-1(OR=1.687,95%CI=1.098~2.592)是后天性心脏瓣膜病患者预后不良危险因素(P<0.05)。结论心脏瓣膜置换术应用于后天性心脏瓣膜病患者,可改善心功能,调节血管内皮功能。LVEF、CI、VEGF、ET-1是后天性心脏瓣膜病患者预后不良影响因素,临床有一定应用价值。Objective To analyze the postoperative cardiac rehabilitation outcomes,changes in endothelial function,and prognostic factors in patients with acquired heart valve disease.Methods Retrospective selection of 80 patients with acquired heart valve disease admitted to Fuyang People's Hospital from February 2022 to February 2024 as the research subjects.The changes in cardiac function index[left ventricular ejection fraction(LVEF),cardiac index(CI)],and endothelial function indicators[vascular endothelial growth factor(VEGF),endothelin-1(ET-1)]of the study subjects before 1 day and 7 days after surgery were compared.All subjects were given cardiac valve replacement.According to whether reoperation or death occurred after 6 months of follow-up,they were divided into poor prognosis group(33 cases)and good prognosis group(47 cases).The factors affecting the prognosis of patients with acquired valvular heart disease were analyzed by univariate and multivariate analysis.Results The levels of LVEF and CI at 7 days after operation were(53.12±4.01)%and(2.63±0.83)L/(min·m^(2)),respectively,which were higher than those at 1 day before operation[(48.87±3.48)%and(2.07±0.41)L/(min·m^(2))],the differences were statistically significant(P<0.05).The levels of VEGF and ET-1 at 7 days after operation were(253.16±23.15)pg/L and(45.15±5.62)ng/L,respectively,which were lower than those at 1 day before operation[(517.42±46.27)pg/L,(81.39±10.08)ng/L],the difference was statistically significant(P<0.05).Univariate analysis showed that there were significant differences in the expression levels of LVEF,CI,VEGF,and ET-1 at 1 day before operation between the poor prognosis group and the good prognosis group(P<0.05).Multivariate regression analysis showed that LVEF(OR=0.530,95%CI:0.302-0.931)and CI(OR=0.585,95%CI:0.377-0.907)were poor prognostic protective factors in patients with acquired valvular heart disease.VEGF(OR=1.521,95%CI:1.116-2.072)and ET-1(OR=1.687,95%CI:1.098-2.592)were risk factors for poor prognosis in acquired valvular

关 键 词：后天性心脏瓣膜病 左室射血分数 心脏指数 血管内皮生长因子 内皮素-1 预后 

分 类 号：R654.2[医药卫生—外科学]