摘要
目的 分析巨大左心房对二尖瓣瓣膜手术后早期心肺功能恢复的影响 ,以及左心房折叠术 (LAP)的早期手术疗效。方法 回顾性分析 1 991年 1月至 2 0 0 0年 1 2月 92例收缩末期左心房内径(LAD)≥ 6 0cm或容积指数 (LAVI)≥ 30 0ml/m2 的二尖瓣手术病人的临床资料 ,并根据手术方式分为LAP组 (63例 )和对照组 (2 9例 )。采用多元Logistic回归分析进行高危因素分析。结果 术后早期并发症发生率和早期病死率分别为 2 2 83 %和 4 35 % ,两组间差异无显著性 (P >0 0 5) ,但呼吸衰竭发生率LAP组(6 35 % )显著低于对照组 (2 4 1 4 % ) (P <0 0 5) ,女性、术前LAVI≥ 60 0ml/m2 、严重肺动脉高压和肺功能下降是术后发生呼吸功能衰竭的独立高危因素 ;而LAP、术前EF≥ 0 50是独立的保护因素 (P <0 0 1 ) ;术后呼吸功能衰竭是早期死亡的独立高危因素 (P <0 0 1 )。术后早期LAD和LAVI均较术前显著减小(P <0 0 1 ) ,尤以LAP组减小显著 (P <0 0 1 )。结论 LAP有利于改善肺功能 ,提高术后早期疗效。对于心脏瓣膜病合并巨大左心房者 ,尤其LAVI≥ 60 0ml/m2 的病人 ,应常规在瓣膜手术同期施行LAP。
Objective: To evaluate the affects of giant left atrium (GLA) and the benefits of left atrial plication (LAP) on the recovery of heart and lung function during early postoperative stage. Methods: Ninety two patients with left atrial diameter (LAD) over 6.0 cm or left atrial endosystolic volume index (LAVI) over 300ml/m 2, who were operated upon for mitral valvular lesions between Jan.1991 and Dec.2000, were studied retrospectively. The patients were divided into LAP group (n=63) and non LAP group (n=29) according to the surgical procedure for GLA. The risk factors for complications and death during early postoperative period were identified using stepwise logistic regression. Results: The overall rates of early complications were 20.63% in LAP group and 25.79% in non LAP group, respectively (P>0.05), incidence of respiratory failure was lower in LAP group (P<0.05). Female gender, preoperative LAVI≥600 ml/m 2, severe pulmonary hypertension and lung dysfunction were the independent high risk factors for postoperative respiratory failure, while LAP and preoperative EF≥0.50 were the independent protective factors (P<0.01). The early mortality rates were 3.17% in LAP group and 6.90% in non LAP group, respectively (P>0.05). Respiratory failure was identified as independent high risk factor for hospital death (P<0.01). LAD, LAV and LAVI were reduced significantly in both groups after operation but in LAP group was more significant than that in non LAP group (P<0.01). Conclusion: LAP has considerably beneficial effect on improvement of postoperative respiratory function and early results. It may be recommended for patients with GLA during mitral valve surgery, especially for patients with LAVI≥600 ml/m 2.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2002年第4期202-204,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
全军"九.五"医药卫生科研基金资助 (基金编号96Z0 31)
关键词
心脏瓣膜疾病
心脏外科手术方法
治疗结果
Heart valve diseases Cardiac surgery procedures Treatment outcome
