左心瓣膜置换术后重度三尖瓣关闭不全再次手术预后的危险因素分析
发布时间：2018-10-22 08:36
【摘要】：目的分析影响左心瓣膜置换术后远期重度三尖瓣关闭不全再次行三尖瓣手术患者围手术期死亡和远期生存的因素,探讨再次手术的恰当时机。方法收集2001年1月至2015年12月在我院胸心外科因左心瓣膜置换术后重度三尖瓣关闭不全面再次行三尖瓣手术治疗的111例患者的临床资料,并对术后生存的患者进行随访,分析影响患者围手术期死亡和远期生存的危险因素。结果 (1) 11例(9.9%)行三尖瓣成形术,100例(90.1%)行三尖瓣置换术,其中机械瓣置换45例,生物瓣置换55例。围手术期死亡11例,死亡率为9.9%,死亡原因为呼吸功能衰竭2例,肾功能衰竭1例,心功能衰竭3例,多器官功能衰竭5例。单因素分析显示术前顽固性右心功能不全(P=0.015)、NYHA心功能IV级(P=0.002)、肺动脉高压(P=0.008)、左心室射血分数(P=0.016)、血清肌酐(P0.001)、总胆红素(P=0.042)、白蛋白(P=0.020)与围手术期死亡有关。多因素Logistic回归分析显示顽固性右心功能不全(OR:44.075,95%CI: 2.602-746.60 2, P=0.009)、肺动脉高压(OR:79.886,95%CI:2.709-2355.405,P=0.011)、左心室射血分数0. 5(OR:29.278,95%CI: 1.413-606.765,P=0.029)、白蛋白35g/L(OR: 21.757,95%CI: 1.246-379.886,P=0.035)是影响围手术期死亡的独立危险因素。(2)围手术期生存100例患者,随访率95%,随访时间8-186个月,平均59.2±39.5月。随访中有10例死亡,其中6例死于心功能衰竭,1例死于感染性心内膜炎,1例死于脑出血,1例死于脑卒中,1例发生猝死。术后1年,5年,10年的累积生存率分别为98.0%, 88.0%, 73.3%。单因素分析显示术前顽固性右心功能不全(Log-rank P0.001)、NYHA 心功能Ⅳ级(Log-rankP=0.026)、左心室射血分数0.5(Log-rank P=0.020)、血肌酐110μmol/L(Log-rank P=0.017)、白蛋白35g/L(Log-rank P=0.037)是影响术后生存的危险因素。多因素Cox回归分析结果显示,术前顽固性右心功能不全为影响术后生存的独立危险因素(HR:7.451,95%CI:2.204-25.190,P=0.001)。(3)术后免于主要心脏不良事件(MACE)的1年,5年,10年累积生存率分别为98.0%,79.9%,63.7%。单因素分析显示术前顽固性右心功能不全(Log-rank P0.001)、NYHA 心功能Ⅳ级(Log-rankP=0.021)、左心室射血分数0.5(Log-rank P=0.032)、血肌酐110μmol/L(Log-rank P=0.013)、白蛋白35g/L(Log-rank P=0.034)是影响术后患者远期免于主要心脏不良事件生存率的危险因素。多因素Cox回归分析结果显示,术前顽固性右心功能不全(HR:4.705,95%CI:2.193-10.093,P0.001)、血肌酐110μmol/L (HR:3.422,95%CI: 1.044-11.219, P=0.042)为影响术后远期免于主要心脏不良事件生存率的独立危险因素。(4)对于术后生存的90例接受三尖瓣置换术(TVR)的患者,机械瓣组(41例)和生物瓣组(49例)的术后累积生存率的差异无统计学意义(Log-Rank P=0.754)。两组患者术后远期免于主要心脏不良事件的累积生存率的差异也无统计学意义(Log-Rank P=0.726)。结论 (1)术前顽固性右心功能不全、肺动脉高压、左心室射血分数0.5、白蛋白35g/L是影响围手术期死亡的独立危险因素。(2)术前顽固性右心功能不全为影响术后远期生存的独立危险因素。(3)术前顽固性右心功能不全、血肌酐110μmol/L为影响术后免于主要心脏不良事件生存率的独立危险因素。(4)对于左心瓣膜置换术后重度三尖瓣关闭不全的患者,手术时机应选择在患者右心功能未发生不可逆性损害,肝肾功能未出现明显异常时积极手术治疗,可能使患者受益。
[Abstract]:Objective To analyze the factors influencing the perioperative death and long-term survival of tricuspid valve replacement in patients with tricuspid insufficiency after valve replacement. Methods The clinical data of 111 patients with severe tricuspid valve closure after aortic valve replacement after valve replacement in our hospital from January 2001 to December 2015 were collected, and the patients who survived were followed up. The risk factors of perioperative death and long-term survival were analyzed. Results (1) 11 cases (90.9%) underwent tricuspid valve replacement, 100 cases (90. 1%) underwent tricuspid valve replacement, in which 45 cases were replaced by mechanical flap and 55 cases with bioprosthesis replacement. The death rate was 9. 9% in 11 cases of perioperative death. The cause of death was respiratory failure (2 cases), renal failure (1), cardiac failure (3 cases) and multi-organ failure (5 cases). The single factor analysis showed that the left ventricular function was not complete before operation (P = 0. 015), NYHA class IV (P = 0. 002), pulmonary hypertension (P = 0.0008), left ventricular ejection fraction (P = 0.0016), serum adiponectin (P0. 001), total bilirubin (P = 0. 034) and albumin (P = 0.020) were associated with perioperative mortality. Multiple logistic regression analysis showed that refractory right ventricular function was incomplete (OR: 44. 967, 95% CI: 2.602-746. 60 2, P = 0.00009), pulmonary hypertension (OR: 79. 886, 95% CI: 2. 709-2355. 405, P = 0.011), left ventricular ejection fraction 0. 5 (OR: 29. 278, 95% CI: 1. 413-606. 765, P = 0.01), albumin 35g/ L (OR: 21. 757, 95% CI: 1. 246-379. 886, P = 0. 034) was an independent risk factor affecting perioperative mortality. (2) In the perioperative period of 100 patients, follow-up rate was 95%, follow-up time was 8-186 months, average 59. 2 72.39. 5 months. Among them, 10 died in follow-up, 6 of them died of cardiac failure, 1 died in infective endomyosis, 1 died in cerebral hemorrhage, 1 died in stroke, and 1 patient died of sudden death. 1-year, 5-year and 10-year cumulative survival rates were 98.0%, 88.0%, 73.3%, respectively. The single factor analysis showed that the left ventricular function was not all the same (Log-type P0.001), NYHA class 鈪，
本文编号：2286660
[Abstract]:Objective To analyze the factors influencing the perioperative death and long-term survival of tricuspid valve replacement in patients with tricuspid insufficiency after valve replacement. Methods The clinical data of 111 patients with severe tricuspid valve closure after aortic valve replacement after valve replacement in our hospital from January 2001 to December 2015 were collected, and the patients who survived were followed up. The risk factors of perioperative death and long-term survival were analyzed. Results (1) 11 cases (90.9%) underwent tricuspid valve replacement, 100 cases (90. 1%) underwent tricuspid valve replacement, in which 45 cases were replaced by mechanical flap and 55 cases with bioprosthesis replacement. The death rate was 9. 9% in 11 cases of perioperative death. The cause of death was respiratory failure (2 cases), renal failure (1), cardiac failure (3 cases) and multi-organ failure (5 cases). The single factor analysis showed that the left ventricular function was not complete before operation (P = 0. 015), NYHA class IV (P = 0. 002), pulmonary hypertension (P = 0.0008), left ventricular ejection fraction (P = 0.0016), serum adiponectin (P0. 001), total bilirubin (P = 0. 034) and albumin (P = 0.020) were associated with perioperative mortality. Multiple logistic regression analysis showed that refractory right ventricular function was incomplete (OR: 44. 967, 95% CI: 2.602-746. 60 2, P = 0.00009), pulmonary hypertension (OR: 79. 886, 95% CI: 2. 709-2355. 405, P = 0.011), left ventricular ejection fraction 0. 5 (OR: 29. 278, 95% CI: 1. 413-606. 765, P = 0.01), albumin 35g/ L (OR: 21. 757, 95% CI: 1. 246-379. 886, P = 0. 034) was an independent risk factor affecting perioperative mortality. (2) In the perioperative period of 100 patients, follow-up rate was 95%, follow-up time was 8-186 months, average 59. 2 72.39. 5 months. Among them, 10 died in follow-up, 6 of them died of cardiac failure, 1 died in infective endomyosis, 1 died in cerebral hemorrhage, 1 died in stroke, and 1 patient died of sudden death. 1-year, 5-year and 10-year cumulative survival rates were 98.0%, 88.0%, 73.3%, respectively. The single factor analysis showed that the left ventricular function was not all the same (Log-type P0.001), NYHA class 鈪，
本文编号：2286660
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