围术期瓣膜替换术死因及相关因素分析

Retrospective Analyses of Related Causes of Postoperative Mortality of Cardiac Valve Replacement

分析了解导致心脏瓣膜替换手术围术期死亡的某些相关因素，以期降低围术期死亡率。收集白１９７６年５月～１９９１年１２月共２２１８例原始病历资料，进行单因素及Ｌｏｇｉｓｔｉｃ多元回归分析。结果显示围术期主要死因依次为低心输出量综合征、严重室性心律失常、人工瓣心内膜炎、脑部并发症和肾功能衰竭。围术期死亡主要相关因素依次为心肌保护不满意、施行手术年代、心脏阻断时间≥１２０分钟或体外循环时间≥１６０分钟、既往有瓣膜手术史、心胸比率≥０．７０、术前心功能Ⅲ、Ⅳ级、主动脉瓣狭窄和术前肺动脉高压。结论为心脏瓣膜替换术围术期死亡的显著相关因素明确，避免出现这些相关因素或存在某些相关因素时，积极采取相应处理措施，可望降低围术期死亡率。

The purpose of this retrospective analysis was to identify some independent predictors that might lead to postoperative death after cardiac valve replacement. Method:Preoperative,intraoperative and postoperative variables of 2218 cases were collected and analyzed retrospectively with univariate test and logistic regression analysis. Result:The main causes of postoperative deaths in sequence were:low cardiac output syndrome,severe ventricular dysrrhythmia dysrrbythmia, prosthetic valve endocarditis, neurological complications and renal failure. Postoperative death was correlated with unsatisfactory myocardial protection, year of operation,aortic cross-clamping time≥120 min or cardiopulmonary bypass time≥160 min, previous cardiac valvular operation,C/T≥0.70, higher NYHA Functional class (III,IV), aortic valvular,stenosis and pulmonary hypertention.Conclusion: The determinants of postoperative death after cardiac valve replacement have been defined. Active measures to avoid the occurrence of these predictors or correct them should be taken so as to decrease postoperative mortality.