摘要
背景心内直视瓣膜置换术是治疗心脏瓣膜病的主要手段,而术中复温阶段心脏能否自动复跳常关系到手术的成败,其影响因素一直备受临床关注。目的探讨心内直视瓣膜置换术中心脏自动复跳的影响因素。方法选取2017年9月—2018年7月安徽省立医院收治的心脏瓣膜病并行心内直视瓣膜置换术患者413例,按照术中复温阶段心脏是否自动复跳分为自动复跳组(n=254)和非自动复跳组(n=159)。比较两组患者性别,年龄,体质指数(BMI),高血压、糖尿病、肾功能不全、呼吸系统疾病、血栓性疾病、房室传导阻滞发生情况,左心室舒张末期内径(LVEDD),左心室后壁厚度(LVPWT),肺动脉收缩压(PASP),左心室射血分数(LVEF),手术方式〔包括二尖瓣置换术(MVR)、主动脉瓣置换术(AVR)、二尖瓣联合主动脉瓣置换术(DVR)〕,主动脉阻断时间,术中输库存血量;心内直视瓣膜置换术中心脏自动复跳的影响因素分析采用二元Logistic回归分析。结果两组患者年龄,BMI,高血压、糖尿病、呼吸系统疾病、房室传导阻滞发生率,PASP,主动脉阻断时间,术中输库存血量比较,差异无统计学意义(P>0.05);两组患者性别、肾功能不全及血栓性疾病发生率、LVEDD、LVPWT、LVEF、手术方式比较,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,肾功能不全〔OR=5.630,95%CI(1.342,23.612)〕、LVPWT≥13 mm〔OR=2.249,95%CI(1.103,4.583)〕、LVEF<50%〔OR=3.164,95%CI(1.732,5.780)〕、AVR〔OR=2.717,95%CI(1.456,5.071)〕、DVR〔OR=2.581,95%CI(1.427,4.665)〕是心内直视瓣膜置换术中心脏自动复跳的危险因素(P<0.05)。结论肾功能不全、LVPTW≥13 mm、LVEF<50%、涉及主动脉瓣置换的术式是心内直视瓣膜置换术中心脏复跳的危险因素,临床应加以重视。
Background Open-heart valve replacement is the main therapeutic measure of valvular heart disease, however intraoperative automatic heart resuscitation at rewarming stage has significant influence on the surgical success or failure,and its influencing factors attract much clinical attention. Objective To explore the influencing factors of automatic heart resuscitation during open-heart valve replacement. Methods A total of valvular heart disease patients underwent openheart valve replacement were selected in Anhui Provincial Hospital from September 2017 to July 2018,and they were divided into A group(with automatic heart resuscitation,n=254)and B group(without automatic heart resuscitation,n=159) according to the incidence of intraoperative automatic heart resuscitation at rewarming stage. Gender,age,BMI,incidence of hypertension,diabetes,renal insufficiency,respiratory disease,thrombosis disease and atrioventricular block,LVEDD, LVPWT,PASP,LVEF,surgical procedures〔including mitral valve replacement(MVR),aortic valve replacement(AVR) and double valves replacement(DVR)〕,aortic-cross clamping time and intraoperative stored blood transfusion volume were compared between the two groups;binary Logistic regression analysis was used to analyze the influencing factors of automatic heart resuscitation during open-heart valve replacement. Results There was no statistically significant difference in age, BMI,incidence of hypertension,diabetes,respiratory disease or atrioventricular block,PASP,aortic-cross clamping time or intraoperative stored blood transfusion volume between the two groups(P>0.05),while there were statistically significant differences of gender,incidence of renal insufficiency and thrombosis disease,LVEDD,LVPWT,LVEF and surgical procedures between the two groups(P<0.05). Binary Logistic regression analysis results showed that,renal insufficiency〔OR=5.630,95%CI (1.342,23.612)〕,LVPWT ≥ 13 mm〔OR=2.249,95%CI(1.103,4.583)〕,LVEF<50%〔OR=3.164,95%CI(1.732, 5.780)〕,AVR〔OR=2.717,95%CI(1.456,5.071)〕and DVR〔OR=2.581,95%CI(1.427,4.665)〕were risk factors of automatic heart resuscitation during open-heart valve replacement(P<0.05). Conclusion Renal insufficiency, LVPWT ≥ 13 mm,LVEF<50% and surgical procedures involving aortic valve replacement are risk factors of automatic heart resuscitation during open-heart valve replacement,which should be pay more clinical attention to.
作者
金秋水
严中亚
JIN Qiushui;YAN Zhongya(Department of Cardiac Macrovascular Surgery,Anhui Provincial Hospital(Provincial Clinical College Affiliated to Anhui Medical University),Hefei 230001,China)
出处
《实用心脑肺血管病杂志》
2019年第1期44-48,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
安徽省科技计划项目(1301042198)
关键词
心脏瓣膜疾病
心脏瓣膜置换术
心脏自动复跳
影响因素分析
Heart valve diseases
Cardiac valve replacement
Automatic heart resuscitation
Root cause analysis
