瓣膜置换术后心律失常危险因素分析  

Risk Factors for Arrhythmia after Valve Replacement

作　　者：傅天瑞 国鹏飞 刘宣蔚 杨宝童 韩娜伟 杨苏民[1] 

机构地区：[1]青岛大学附属医院心血管外科,山东 青岛 [2]首都医科大学附属北京世纪坛医院心血管外科,北京 [3]青岛大学附属医院康复医学科,山东 青岛

出　　处：《临床医学进展》2023年第5期8070-8082,共13页Advances in Clinical Medicine

摘　　要：背景:目前瓣膜病已经成为严重危害人群健康的疾病,保守估计我国目前约2500万心脏瓣膜病患者。外科手术是解决病因的最佳途径。随着外科技术的日益发展,瓣膜病的外科治疗由20世纪70年代后期的闭式扩张分离术,至今,伴随着体外循环技术的发展,心脏停跳液的进步以及最重要的瓣膜的迭代,心脏瓣膜置换手术已然成为一项成熟的方式。不论是单个瓣膜的置换手术,还是联合瓣膜的手术,从手术数量以及死亡率来看,我国的瓣膜置换手术已然达到国际先进水平。然而,尽管目前心脏瓣膜置换手术技术越发成熟,手术死亡率显著降低。然而术后并发症的所带来的影响却不可忽视。心律失常是瓣膜置换手术最常见的并发症之一,轻者诸如房性早搏,还有大多数的心房颤动甚至可以自行转复,严重者诸如室性心动过速,室性颤动则是导致术后ICU住院时间延长,预后差,甚至是早期死亡的重要原因之一。目的:本研究的目的是通过比较正中开胸直视下瓣膜置换术术后发生心律失常与未发生心律失常的患者的相关指标,探讨能提示或导致术后心律失常危险因素,减少患者心律失常术后发生率。方法:回顾性分析194名自2021年1月1日起于我院行心脏瓣膜置换手术的患者(男80,女114),按照是否发生瓣膜置换术后的心律失常,将其分为实验组(发生心律失常患者,80例,男37,女47,平均年龄63.0岁)及对照组(未发生心律失常患者,114例,男43,女67,平均年龄62.0岁)。比较两组临床资料,术后是否发生心律失常的单因素分析采用卡方检验以及秩和检验,而后对于P < 0.05的变量采用logistic回归模型进一步分析与术后心律失常的相关性。结果:心脏瓣膜置换术后新发心律失常80例,在本研究中,患者年龄、既往糖尿病史、高血压史、脑梗病史、既往开胸心脏手术史、术前肌酐、血钾、血镁、高敏肌钙蛋白�Background: At present, valvular disease has become a serious disease that endangers the health of the population, and it is conservatively estimated that there are currently about 25 million patients with valvular heart disease in China. Surgery is the best way to address the cause. With the increasing development of surgical technology, the surgical treatment of valvular disease has changed from closed dilation separation in the late 70s of the 20th century, and so far, with the development of cardiopulmonary bypass technology, the advancement of cardiac arrest fluid and the iteration of the most important valve, heart valve replacement surgery has become a mature method. Whether it is a single valve replacement surgery or a combined valve operation, from the perspective of the number of operations and mortality, China’s valve replacement surgery has reached the international advanced level. However, despite the current maturity of heart valve replacement surgery, surgical mortality has been significantly reduced. However, the impact of postoperative complications cannot be ignored. Arrhythmia is one of the most common complications of valve replacement surgery, mild such as atrial premature beats, and most atrial fibrillation can even be converted on its own, severe cases such as ventricular tachycardia, ventricular fibrillation is one of the important causes of prolonged postoperative ICU stay, poor prognosis, and even early death. Objective: The objective of this study is to reduce the incidence of arrhythmia in patients with arrhythmia after median open-eye valve replacement and patients without arrhythmia by comparing the relevant indicators of arrhythmia after median open-eye valve replacement with those without arrhythmia. Methods: A retrospective analysis was performed for 194 patients (80 males and 114 females) who underwent heart valve replacement surgery in our hospital since January 1, 2021, and they were divided into experimental group (80 patients with arrhythmia, 37 males, 47 females, average a

关 键 词：瓣膜置换手术 心律失常 危险因素分析 

分 类 号：R54[医药卫生—心血管疾病]