风湿性心脏瓣膜替换术后远期疗效观察

Analysis of Long-Time Efficacy Valve Replacement for Rheumatic Heart Disease

目的:分析风湿性心脏病瓣膜替换术后远期疗效及其影响因素。方法:我院1980年-2004年施行心脏瓣膜替换613例,早期死亡30例。术后获访495例,获访时间为2700病人年, 平均5．45病人年。结果:晚期死亡37例。晚期死亡率1．61％病人年。机械瓣和生物瓣晚期死亡率分别为1．10％和6．10％病人年,15 年生存率分别为89．3％和43．1％。结论:影响心脏瓣膜替换晚期疗效主要因素为抗凝不当、术前心功能、年龄和心房颤动。机械瓣替换术晚期死亡原因主要为抗凝有关并发症、心室颤动、细菌性心内膜炎和心力衰竭,而生物瓣膜替换术晚期死亡原因则为生物瓣衰败。

Objective：To analyze late effect and factors influencing late effect after valve replacement for rheumatic heart disease. Methods： From January 1980 to December 2004, valve replacement were performed in 613 patients with rheumatic heart disease. There was 30 early deaths 495 were followed-up for,2700 patient-years, with the mean follow-up time was 5.45% patient- years. Results：There were 37 late deaths,with the death rate of 1.40% （patient-years）. The 15-year actual survival rates were 89. 3% and 43.1%, and the late death rates were 1.10% and 6. 1% （patient-years）for mechanical and bioprosthetic valves, respectively. Conclusion： Factors influencing late effect were anticoagulatin-related complications, preoperative cardiac function, age and arterial fibrillation. Late death for mechanical valve replacement were associated with anticoagulation-related copmlications, ventricular arrhythmias, bacterial endocarditis and cardiac failure, but for bioprosthetic valves were due to wear-out failure.