心脏再次手术置换主动脉瓣临床研究

Clinical study of cardiac re-surgery for aortic valve replacement

目的对再次心脏手术置换主动脉瓣的原因、疗效及术后死亡危险因素进行分析研究。方法 2008年1月～2015年12月期间于我院行再次心脏手术置换主动脉瓣的患者86例,收集分析其临床资料,观察治疗效果。结果 再次心脏手术置换主动脉瓣的原因主要包括主动脉瓣风湿性病变加重、退行性主动脉瓣病变、感染性心内膜炎赘生物形成、人工瓣膜障碍。存活患者手术前后各项指标均得到显著改善,差异具有统计学意义（P〈0.05）。术后死亡的危险因素为术前肌酐≥100 mol/L。结论 再次心脏手术置换主动脉瓣受多因素的广泛影响,心脏手术前肌酐水平升高会增加手术风险,再次心脏手术置换主动脉瓣疗效肯定。

Objective To analyze the causes, effects and risk factors of death after cardiac re-surgery for aortic valve replacement. Methods The clinical data of 86 patients with cardiac re-surgery for aortic valve replacement in our hos- pital from January 2008 to December 2015 were collected and analyzed and the therapeutic effect was observed. Re- sults The main causes of cardiac re-surgery for aortic valve replacement were aortic valve rheumatic disease exacerba- tion, degenerative aortic valve disease, infective endocarditis vegetations and prosthetic valve dysfunction. The indices of the survival patients before and after surgery were significantly improved and the difference was statistically signifi- cant（P〈0.05）. The risk factor for death after surgery was the level of preoperative creatinine ≥ 100 mol/L. Conclusion Cardiac re-surgery for aortic valve replacement is affected by multiple factors. The increase in the level of preoperative creatinine will increase the risk of surgery and the effect of cardiac re-surgery for aortic valve replacement is positive.