新疆地区心脏瓣膜置换术后死亡危险因素分析

Risk Factors of In-hospital Death at er Heart Valve Replacement in Xinjiang

目的分析新疆地区心脏瓣膜置换术后患者在院死亡的危险因素。方法回顾性分析2011年5月至2014年3月新疆医科大学第一附属医院心脏外科施行心脏瓣膜置换术214例患者的临床资料,其中男96例、女118例,年龄(49.91±13.27)岁。根据术后是否死亡将患者分为2组(死亡组21例、存活组193例),分析围手术期死亡的危险因素。结果全组在院死亡21例(9.81%),2组患者在术前凝血酶原时间(PT)、左心室射血分数(LVEF)≤50%、术前心功能Ⅳ级、肺动脉压力>60 mm Hg、体外循环时间≥2 h、是否合并冠心病、肾功能不全方面差异有统计学意义(P<0.05)。Logistic回归分析表明,术前PT缩短、肺动脉压力>60 mm Hg、心功能Ⅳ级、LVEF≤50%为心脏瓣膜置换术后在院死亡的独立危险因素。结论新疆地区患者心脏瓣膜置换术后在院死亡的独立危险因素为术前PT缩短、肺动脉压力>60 mm Hg、心功能Ⅳ级、LVEF≤50%,对于合并有上述危险因素的患者,应提高警惕,积极调控危险因素后再行外科手术。

Objective To investigate risk factors of in-hospital death of patient after heart valve replacement（HVR） in Xinjiang. Methods We retrospectively analyzed clinical data of 214 patients undergoing HVR in the First Teaching Hospital of Xinjiang Medical university from January 2011 to Month 2014. There were 96 male and 118 female patients with their age of 49.91±13.27 years. According to their postoperative prognosis, all the patients were divided into a death group（21 patients） and a survival group（193 patients）. Risk factors of perioperative death were analyzed. Results In-hospital mortality was 9.81%（21/214）. There was statistical difference in preoperative prothrombin time（PT）, incidences of left ventricular ejection fraction（LVEF） ≤ 50%, NYHA class Ⅳ, pulmonary arterial pressure（PAP） 60 mm Hg, cardiopulmonary bypass time ≥ 2 hours, concomitant coronary artery disease and renal failure between the 2 groups（P〈0.05）. Logistic regression analysis showed that shortened preoperative PT, PAP〉60 mm Hg, NYHA class Ⅳ and LVEF ≤ 50% were independently risk factors of in-hospital death after HVR（P〈0.05）. Conclusions Independent risk factors of in-hospital death of patients after HVR in Xinjiang include shortened preoperative PT, PAP60 mm Hg, NYHA class Ⅳ and LVEF ≤ 50%. Heightened caution is needed for patients with above risk factors to receive HVR after correction of those risk factors.