心脏术后继发性三尖瓣关闭不全再次行三尖瓣置换术的危险因素分析

Analysis of risk factors of tricuspid valve replacement for patients with secondary tricuspid regurgitation after cardiac surgery

目的回顾性分析心脏术后三尖瓣关闭不全行三尖瓣置换术死亡危险因素,评价New Euro SCOREⅡ对三尖瓣置换术后风险的预测作用。方法回顾性分析77例心脏术后再次行三尖瓣置换术病例的临床资料,对入选者的临床资料进行单因素及多因素统计学分析。结果单因素分析显示,术前NYHAⅣ级、右心衰、肺动脉压力、总胆红素、肌酐、尿素、尿酸,以及术中体外循环时间、心肌保护液量、升主动脉阻断时间、置换瓣膜大小与术后早期死亡有统计学意义(P<0.05)。术前肌酐升高、无心房颤动是心脏术后再次行三尖瓣置换术早期患者死亡的独立危险因素(P<0.05)。死亡组与非死亡组Euro SCORE评分的差异有统计学意义。结论心脏术后远期因三尖瓣关闭不全行三尖瓣置换术前要特别注意对肾功能异常患者的准备工作,New Euro SCOREⅡ可以作为预测此类手术风险的可靠评分系统。

Objective To retrospectively analyze death risk factors of tricuspid valve replacement for patients with tricuspid regurgitation after cardiac surgery and evaluate the risk prediction of New EuroSCORE Ⅱ after tricuspid valve replacement.Methods The clinical data of 77 patients who underwent the tricuspid valve replacement after cardiac surgery were retrospectively analyzed and univariate analysis and multivariate analysis were conducted.Results The univariate analysis showed that NYHA class Ⅳ,right heart failure,elevated pulmonary artery pressure,total bilirubin,creatinine,urea,uric acid,sinus rhythm,cardiopulmonary bypass time,protection fluid,blocking time,and smaller prosthesis during the operation were statistically significant for early postoperative death（P〈0.05）.Elevated creatinine before operation and absence of atrial fibrillation were independent risk factors of early death of patients undergoing the tricuspid valve replacement after cardiac surgery（P〈0.05）.The difference of EuroSCORE between the death group and survival group was statistically significant.Conclusion Attention should be paid to patients with abnormal renal function who will undergo the tricuspid valve replacement after cardiac surgery due to tricuspid regurgitation.New EuroSCORE Ⅱ is a reliable scoring system for predicting the risk of operation.