心脏瓣膜置换手术围手术期相关危险因素分析

发布时间：2018-01-30 15:28

本文关键词： 心脏瓣膜病风湿性心脏病瓣膜置换危险因素　出处：《四川大学学报(医学版)》2017年05期 　论文类型：期刊论文

【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。
[Abstract]:Objective to analyze and evaluate the valvular heart disease underwent valve replacement surgery, perioperative risk factors of rheumatic heart disease undergoing valve replacement surgery. Methods patients were collected from August 2012 to January 2015 in West China Hospital of Sichuan University underwent valve replacement surgery (2696 cases). Clinical data of all risk factors by the Spearman correlation analysis and screening, then uses the multi factors logistic regression analysis finally obtained risk factors significantly associated with end point events. Results when the end point events for in-hospital death, and cardiopulmonary bypass time [standard partial regression coefficient (B) = 0.418), cardiac function classification (B '=0.344) and pulmonary hypertension (B =0.285). When the end point event for the postoperative complications (with ventilation time for the characterization), heart function classification (B' =0.520), pulmonary hypertension (B =0.365), cardiopulmonary bypass time (B =0.306), diabetes (B =0.129) The left ventricular diameter (B, =0.118) and pulmonary regurgitation (B =0.071) is the main risk factors. In rheumatic heart disease undergoing cardiac valve replacement in patients with heart function classification (B '=0.578), pulmonary hypertension (B =0.401), cardiopulmonary bypass time (B' =0.305) and diabetes (B '=0.143) is rheumatic heart disease undergoing valve replacement surgery complications (with ventilation time for the characterization of) the main risk factors of left ventricular ejection fraction, and the common risk factors for the first time at high Yin. Conclusion cardiac function grade and presence of pulmonary hypertensionph is death risk factors of patients with valve replacement surgery, but also because of valvular heart disease (including rheumatic heart disease) the common risk factors of complications underwent valve replacement surgery patients after operation.

【作者单位】：四川大学华西医院心脏大血管外科;
【分类号】：R654.2
【正文快照】： 心脏瓣膜疾病是常见的心脏疾病之一,手术是其主要且有效的治疗方式。而心脏瓣膜术后死亡及并发症的预测及其相关危险因素一直是医务工作者研究的重点。据既往报道,心脏瓣膜手术死亡率多在4%~8%左右[1]。其主要的术后并发症包括低心排综合征、心律失常、神经系统并发症等。而从

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