方 智, 张尔永.心脏瓣膜置换手术围手术期相关危险因素分析.四川大学学报(医学版),2017,48(5):750-754
心脏瓣膜置换手术围手术期相关危险因素分析
Risk Factors Associated with the Outcomes of Heart Valve Replacement
  
中文关键词:  心脏瓣膜病 风湿性心脏病 瓣膜置换 危险因素
英文关键词:Valvular heart disease Rheumatic heart disease Valve replacement Risk factors
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中文摘要:
      目的 分析及评价心脏瓣膜病行瓣膜置换手术,探讨风湿性心脏病行瓣膜置换手术的围手术期相关的危险因素。方法 收集四川大学华西医院2012年8月至2015年1月行瓣膜置换手术患者(2 696例)临床资料。所有危险因素经Spearman相关性分析筛选,再采用多因素logistic回归分析筛选最终得到与终点事件明显相关的危险因素。结果 当终点事件为院内死亡时,与体外循环时间〔标准偏回归系数( B’)=0.418)〕、心功能分级( B’=0.344)和肺动脉高压( B’=0.285)有关。当终点事件为术后并发症(以呼吸机带机时间延长为表征)时,心功能分级( B’=0.520)、肺动脉高压( B’=0.365)、体外循环时间( B’=0.306)、糖尿病( B’=0.129)、左室内径( B’=0.118)和肺动脉瓣关闭不全( B’=0.071)是其主要危险因素。在风湿性心脏病行瓣膜置换术的患者中,心功能分级( B’=0.578)、肺动脉高压( B’=0.401)、体外循环时间( B’=0.305)和糖尿病( B’=0.143)则是风湿性心脏病行瓣膜置换手术术后并发症(以呼吸机带机时间延长为表征)的主要危险因素,而左室射血分数这一常见危险因素首次报阴。结论 高心功能分级和存在肺动脉高压是患者瓣膜置换手术死亡的主要危险因素,也是因心脏瓣膜疾病(包括风湿性心脏病)行瓣膜置换手术的患者术后并发症共同的危险因素。
英文摘要:
      【Abstract】 Objective To determine risk factors associated with the outcomes of heart valve replacement, especially in the patients with rheumatic heart disease (RHD). Methods Data were extracted from 2 696 patients who received valve replacement from August 2012 to January 2015. Spearman correlation analyses were performed to identify potential risk factors. Logistic regression models were established to determine risk factors associated with deaths and complications. Results Duration of cardiopulmonary bypass (CPB) 〔standard partial regression coefficient ( B’)=0.418〕, heart function ( B’=0.344) and pulmonary hypertension ( B’=0.285) were significant predictors of deaths in hospitals. The prevalence of complications was associated with heart function ( B’=0.520), pulmonary hypertension ( B’=0.365), CPB duration ( B’=0.306), diabetes ( B’=0.129), left ventricular diameter ( B’=0.118) and pulmonary regurgitation B’=0.071). For patients with RHD, significant predictors of complications included heart function ( B’=0.578), pulmonary hypertension ( B’=0.401), CPB duration ( B’=0.305) and diabetes ( B’=0.143). Left ventricular ejection fraction was not significant in the regression models. Conclusion Chronic renal failure, heart function and CPB duration are associated with postoperative deaths in patients with heart valve replacement, while diabetes, heart function and pulmonary hypertension are significant predictors of postoperative complications. For RHD patients, diabetes, heart function and pulmonary hypertension are major risk factors associated with postoperative complications.
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