摘要
背景:积极加强对高危患者心脏瓣膜置换前、中和置换后的处理,可降低心脏瓣膜置换后早期死亡率。目的:分析心脏瓣膜病患者置换治疗后早期住院死亡的危险因素,提高手术治愈率。方法:回顾分析488例心脏瓣膜病患者行手术治疗作为临床资料;以置换后早期住院死亡为研究终点,采用单因素及多因素Logistic回归方法分析置换后早期死亡的危险因素。结果与结论:488例心脏瓣膜置换患者中,置换后早期死亡27例,总死亡率5.5%。主要的死亡原因是低心排综合征、恶性心律失常、多器官功能衰竭。单因素分析显示:年龄≥60岁、心功能IV级、联合瓣膜手术以及同期冠状动脉旁路移植、左室射血分数≤50%、左室舒张末内径≥70 mm、体外循环时间≥120 min、主动脉阻断时间≥60 min与心脏瓣膜后死亡的发生具有相关性(P<0.05)。多因素Logistic回归分析结果:年龄≥60岁、心功能IV级、瓣膜手术同期冠状动脉旁路移植、体外循环时间≥120 min、左室射血分数≤50%、左室舒张末内径≥70 mm是影响心瓣膜置换后早期死亡的独立危险因素。重视围手术期处理,针对这些因素合理把握手术指征、选择合适的手术方式以及心肌保护,可以进一步降低这类患者手术并发症和病死率。
BACKGROUND： Actively strengthening the perioperative management in high-risk patients undergoing heart valve replacement can reduce early mortality after heart valve replacement.
OBJECTIVE： To analyze the early postoperative risk factors for in-hospital mortality in patients with valvular heart diseases, and to improve surgical cure rate.METHODS： A total of 488 patients with rheumatic valvular heart disease who had received heart valve replacement were retrospectively analyzed. The study was completed until early hospital death after heart valve replacement. Univariate and multivariate logistic regression analysis of postoperative risk factors for early death was performed.RESULTS AND CONCLUSION： Among 488 cases with heart valve surgery, early postoperative deaths occurred in 27 cases, with the total mortality of 5.5%. The main causes of death were low cardiac output syndrome, malignant arrhythmia, and multi-organ failure. Univariate analysis showed that： Age ≥ 60 years, class Ⅳ heart function, valve surgery combined with concomitant coronary artery bypass grafting over the same period, left ventricular ejection fraction ≤ 50%, left ventricular end-diastolic diameter ≥ 70 mm, cardiopulmonary bypass time ≥ 120 minutes, aortic clamping time ≥ 60 minutes were related to the occurrence of death after heart valve replacement （P 〈 0.05）. Multivariate logistic regression analysis showed that： Age ≥ 60 years, class Ⅳ heart function, valve surgery combined with concomitant coronary artery bypass grafting, cardiopulmonary bypass time ≥ 120 minutes, left ventricular ejection fraction ≤ 50%, left ventricular end-diastolic diameter ≥ 70 mm were independent risk factors for early death after heart valve surgery were independent risk factors for early death. Emphasis on perioperative management, a reasonable grasp of these factors for surgical indications, selection of the appropriate surgical approach and myocardial protection can further reduce surgical complications and mortality in these patients.
出处
《中国组织工程研究》
CAS
CSCD
2013年第53期9145-9150,共6页
Chinese Journal of Tissue Engineering Research
作者简介
陈京伟，男，1987年生，河南省南乐县人，汉族，新疆医科大学在读硕士，主要从事心脏外科方面的研究。chenjingwei925@126．com
通讯作者：霍强，博士，主任医师，硕士生导师，主要从事心脏疾病的外科治疗方面的研究。Huoqiangxinjiang@126．com
