主动脉瓣病变致巨大左室患者瓣膜替换围术期严重室性心律失常相关因素及处理

Retrospective analysis and treatment of risk factors determining severe ventricular arrhythmias during perioperative period in patients with giant left ventricular caused by aortic valve disease undergoing cardiac valve replacement

目的探讨主动脉瓣病变致巨大左室患者围术期发生严重室性心律失常的相关因素。方法回顾性分析我院收治的主动脉瓣病变伴巨大左心室施行瓣置换手术122例患者的临床资料,采用单因素和多因素Logistic回归方法分析围术期严重室性心律失常的高危因素。结果术前室性早搏或左前分支阻滞、电解质紊乱(低钾低镁)、心功能(NY-HA分级)Ⅳ级、主动脉阻断时间≥120 m in和手术后低心排出量综合征是围术期发生严重室性心律失常的独立高危因素。结论主动脉瓣病变致巨大左室患者瓣膜置换围术期发生严重心律失常危险因素明确。加强围术期综合处理,积极采取相应处理措施,可望降低围术期死亡率。

Objective To analyze the risk factors of severe ventricular arrhythmias and its treatment during perioperative period in patients with giant left ventricular mainly caused by aortic valve disease undergoing cardiac valve replacement and elevate surgical therapeutic efficacy. Methods The clinic date of 122 patients with giant left ventrieular mainly caused by aortic valve disease undergoing cardiac valve replacement which were studied retrospectively between Mar. 2000 and Oct. 2008. The risk factors of severe ventricular arrhythmias were identified by using univariate and multivariate logistic regression analysis. Results The high risk factors of severe ventrieular arrhythmias were preoperative premature contractions or left anterior division block, electrolyte disturbance, NYHA function class Ⅳ ,aortic-cross clamping time ≥ 120 min and low cardiac output syndrome after operation respectively. Conclusion The determinants of severe ventricular arrhythmias in patients with giant left ventricular mainly caused by aortic valve disease undergoing cardiac valve replacement have been defined. Active measures to avoid occurrence of these predictors or correct them should be taken so as to decrease postoperative mortality.