136例巨大左室瓣膜置换术后并发症危险因素分析

Perioperative risk factors analysis after cardiac valve replacement for patients with very large left ventricle

目的分析巨大左室瓣膜置换术后危险因素,提高术后监护救治水平。方法SPSS二分类Logistic回归分析本院1998年1月至2005年6月收治的136例巨大左室[左室舒张末期前后径(LVED)>70mm]患者的术后危险因素。结果术后主要并发症为心律失常52例(38.2%),活动性出血26例(19.1%),心包填塞8例(5.9%),低心排出量综合征7例(5.1%),低氧血症者8例(5.9%),肺部感染3例(2.2%)。术后早期病死率为6.6%,死亡原因为室颤(2.2%)、低心排(2.2%)、ARDS(0.7%)、多器官功能衰竭(1.5%)。经SPSS二分类Logistic回归分析显示,术中转流时间、阻断时间、呼吸机支持时间、心肌酶谱水平是术后死亡和并发症发生的危险因素。巨大左室与术后呼吸机辅助时间(r=0·206,P<0·05)、并发症发生(r=0·342,P<0·01)、术后心功能(r=0·386,P<0·01)和术后AST变化(r=0·304,P<0·05)呈显著正相关。结论巨大左室瓣膜置换术后各种并发症发生率高,患者术中转流阻断时间长、心肌保护不良、长时间呼吸机辅助呼吸等因素可能是术后患者死亡和并发症发生的危险因素。

Objective To analyze the risk factors of perioperative death and complications after cardiac valve replacement for patients very large left ventricle （left ventricular end diastolic diameter LVED 〉 70 mm）. Methods The authors retrospectively reviewed the clinical data collected between January 1998 and June 2005 of 136 patients after cardiac valve replacement. A binary logistic regression analysis was performed to define the risk factors for the perioperative mortality and complications. Results The postoperative major complications comprised arrhythmia in 52 cases （38.2%） , ventricular premature beats in 34 cases （25%） , atrial fibrillation in 18 cases （13.2%）, hemorrhage in 26 cases （19.1%）, pericardiac tamponade in 8 cases （5.9%）, low output syndromes in 7 cases （5. 1% ） , hypoxemia in 8 cases （5.9%） , and pulmonary infection in 3 cases （2.2%）. The perioperative mortality rate was 6.6%. The causes of death were ventricular fibrillation in 3 cases （2.2%） , low output syndrome in 3 cases （2.2%） , acute respiratory distress syndrome in 1 case （0.7%） and multiple organ failure in 2 cases （ 1. 5% ）. Binary logistic regression analysis showed prolonged aortic cross-clamping time and cardiopulmonary bypass time, ventilation time, and myocardial zymogram as independent risk factors of early mortality and complications. LVED 〉 70 mm was independently associated with the complications and of positive correlation to the ventilation time （ r = 0. 206, P 〈 0.05 ）, New York Heart Association cardiac class （r =0. 386, P 〈 0. 01 ）, and postoperative AST （ r =0. 304, P 〈0.05）. Conclusion Perioperative complications were higher in the procedures of valve replacement for large left ventricle. Prolonged aortic cross-clamping time, cardiopulmonary bypass time, ventilation time, and unsatisfactory myocardial protection were the risk factors of perioperative mortality and complications.