国人机械瓣膜置换手术后远期随访和抗凝治疗现状

Long-term follow up of Chinese with mechanical prosthetic heart valve replacement and the status quo of anti-coagulation treatment

目的 通过对 4 5 0 5例人工机械瓣膜置换病人的远期临床结果随访 ,全面评价国人人工机械瓣膜置换手术的远期疗效和人工机械瓣膜置换手术后抗凝治疗现状 ,以指导临床工作。方法 1976年 5月至 1997年 5月实施人工机械瓣膜置换手术 4 5 0 5例 ,共置换人工机械瓣膜 5 72 9枚。总随访率为 87% ,平均随访 5 5 6年 ( 0 80～ 2 0 17年 ) ,随访总人年数为 2 0 882 4 7病人 年。结果 30d死亡 173例( 3 84 % )。 5 8例发生血栓形成及血栓栓塞 ( 0 2 8%病人 年 ) ,2 73例 ( 1 31%病人 年 )发生出血事件 ,5例再手术 ( 0 0 2 %病人 年 )。远期随访死亡 15 2例 ( 0 73%病人 年 ) ,5年生存率 ( 96 4 9± 0 33) % ,10年 ( 92 6 9± 0 75 ) % ,15年 ( 90 78± 1 5 4 ) %。 88 8%病人了解换瓣术后服用抗凝药物的必要性 ,11 2 %病人不了解抗凝治疗的必要性。抗凝知识的掌握、抗凝治疗检测等与病人文化水平和地区分布有密切关系。结论 远期随访结果表明 ,国人人工机械瓣膜置换术后具有良好远期生存率。部分病人不了解抗凝治疗的重要性 ,抗凝治疗方面存在地区差异。

Objective: The aim of this study is to appraised the long term results of Chinese person with artificial mechanical valve replace and the status quo of anti coagulation treatment after the operation, through long term follow up of 4505 patients with mechanical prosthetic heart valve replacement. Methods: From May 1976 to May 1997, 4505 artificial mechanical valve prostheses replacements were performed, and 5729 prosthetic valves were implanted. The mean follow up period was 5.56 years (0.80～ 20.17yrs) . Total follow up was 20882.47 patient years. The follow up was completed in 87% of the patients. Results: Operative mortality was 3.84%. The linearized rate of thromboembolism was 0.28%pt yr, the rate of bleeding event 1.31%pt yr, and the rate of re operation 0.02%pt yr, The mortality was 0.73%pt yr, the actuarial probability of survival was (96.49±0.33)% at 5 years , (92.69±0.75)% at 10 years, (90.78±1.54)% at 15 years. About 88.8% of the patients understood the significance of the treatment of anticoagulation after operation, whereas 11.2% of the patients did not. The measures of the anticoagulation treatment were closely related with the patients' education levels and the region of residency. Conclusion: Artificial mechanical heart valve replacement in Chinese patients has yielded a good long term survival rate. Education levels and the regions of residency could influence the effects of anticoagulation treatment.