心脏瓣膜置换术后慢性左室收缩功能不全相关因素分析

发布时间：2018-01-15 16:22

本文关键词：心脏瓣膜置换术后慢性左室收缩功能不全相关因素分析　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：随着体外循环灌注、心肌保护、麻醉技术、人造瓣膜的研究、手术水平的提高等方面取得了令人瞩目的进步，但仍有部分患者换瓣术后心功能不仅未得到明显的改善反而出现了降低。为进一步提高瓣膜置换术后患者的生存质量，以进一步指导临床工作，本文就针对心脏瓣膜置换术后慢性左室收缩功能不全的发生的相关因素进行探讨。方法：从福建医科大学附属协和医院病案室收集2008年1月1日至2012年12月31日期间选出心功能正常组及心功能不全组作为研究对象。从已确定的研究对象的临床资料中选取可能与慢性左心收缩功能不全的临床变量，确定各入选临床变量的取值方式，，再将全部入选临床变量分为分类变量和连续变量两大类，最后采用Logistic回归分析。结果：（1）从总体水平出发研究，心脏瓣膜置换术后慢性左室收缩功能不全的相关因素有：术前左室收缩末期内径（P＜0.001）、二尖瓣保留情况（P=0.043）、术前是否合并房颤（P=0.007）、术前是否出现晕厥（P=0.022）、术后是否使用肾上腺素（P=0.032）、术前左室射血分数（P=0.003）。（2）从瓣膜置换术的种类出发研究，单纯二尖瓣置换术的独立相关因素有：性别（P=0.002），同期是否行左房折叠（P=0.013）、二尖瓣类型（国产还是进口）（P=0.003）。单纯主动脉瓣置换术：术前左室射血分数（P＜0.001）、术后是否使用肾上腺素（P=0.025）、术后是否使用多巴酚丁胺（P=0.029）、ICU住院时间（P=0.049）。同期行二尖瓣及主动脉瓣置换术：术前左室射血分数（P＜0.001）。结论：心脏瓣膜置换术后左室收缩功能不全的相关因素有：术前左室收缩末期内径，术前左室射血分数、二尖瓣保留情况、术前是否合并房颤、术前是否出现晕厥、性别、同期有无行左房折叠、二尖瓣类型（国产还是进口）、术后是否使用肾上腺素、术后是否使用多巴酚丁胺、ICU住院时间。
[Abstract]:Objective: with the development of cardiopulmonary bypass (CPB) cardiopulmonary bypass (CPB), myocardial protection, anesthetic technique, artificial valve research, and the improvement of surgical level, etc, remarkable progress has been made. But there are still some patients after valve replacement heart function has not been significantly improved but decreased. In order to further improve the quality of life of patients after valve replacement in order to further guide the clinical work. This paper discusses the related factors of chronic left ventricular systolic dysfunction after cardiac valve replacement. Methods:. From January 1st 2008 to December 31st 2012, the patients with normal cardiac function and heart failure were selected from the medical records department of Union Hospital of Fujian Medical University. The clinical data of the subjects were selected from the clinical variables that may be associated with chronic left ventricular systolic dysfunction. The clinical variables were divided into two categories: classified variables and continuous variables. Finally, Logistic regression analysis was used. Results the relative factors of chronic left ventricular systolic dysfunction after valvular replacement were as follows: preoperative left ventricular end-systolic diameter (P < 0.001). The mitral valve retention was 0.043%, whether atrial fibrillation was associated with P0. 007, and whether there was syncope before operation was 0. 022 (P < 0. 022). Whether or not to use adrenocephalin 0.032, left ventricular ejection fraction (LVEF) before operation was studied from the type of valve replacement. The independent related factors of simple mitral valve replacement were as follows: sex was 0.002, and left atrial folding was performed at the same time (P = 0.013). Mitral valve type (domestic or imported). Simple aortic valve replacement: left ventricular ejection fraction (LVEF) before operation (P < 0.001). Whether to use adrenocephalin 0.025 or dobutamine 0.029 after operation. ICU was treated with mitral valve replacement and aortic valve replacement at the same time (P < 0.001). Conclusion: the related factors of left ventricular systolic dysfunction after cardiac valve replacement are left ventricular end-systolic diameter preoperative left ventricular ejection fraction mitral valve retention and atrial fibrillation before operation. Whether syncope occurred before operation, sex, left atrial folding, mitral valve type (domestic or imported), adrenaline after operation, and hospitalization time of ICU with dobutamine after operation.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2

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