巨大左心室心瓣膜置换术后近中期的疗效以及危险因素分析

Efficacy and risk factors of cardiac valve replacement surgery in the medium term for patients with giant left ventricular

目的观察巨大左心室患者行心脏瓣膜置换手术后近中期的手术疗效以及探讨影响其预后的相关危险因素。方法回顾性分析82例心瓣膜病合并巨大左心室患者行心瓣膜置换术的临床资料,比较术前术后近中期的心脏大小以及心脏功能的改变,并探讨影响其预后的相关危险因素。结果术后近中期左心房内径、左心室舒张期末内径、左心室收缩期内径(LVESD)均较术前减小,差异有统计学意义(P<0.05),而术后左心室射血分数值、左心室缩短率值与术前比较差异无统计学意义,术后心功能分级(NYHA)与术前比较差异有统计学意义(P<0.05);影响患者预后的相关危险因素有术前LVESD值≥6.0 cm、心功能NYHA分级在Ⅳ级、术后未使用血管紧张素转化酶抑制剂(ACEI)类药物或者β-受体阻滞剂(P<0.05)。结论心瓣膜病合并巨大左心室患者行心瓣膜置换术后围手术期死亡率低,且术后近中期心脏的形态大小发生了明显的逆重构过程,心功能同样明显改善,手术疗效满意。心功能Ⅳ级、LVESD≥6.0 cm、术后未使用小剂量的ACEI类药物或β-受体阻滞剂是影响预后的主要危险因素。

Objective To explore the effect of cardiac valve replacement surgery in the medium term on patients with giant left ventricular and its related risk factors. Methods Retrospective analysis the clinical data of 82 cases of valvular heart disease with giant left ventricle underwent heart valve replacement surgery. To compare the size and function of heart between preoperation and postoperation, and explore the relevant risk factors affecting the prognosis. Results The left atrial diameter, left ventricular end diastolic diameter, and left ventricular systolic di- ameter （LVESD） were decreased after the operation, and the difference was statistically significant （ P 〈 0.05 ）. There was no significant difference between left ventricular ejection fraction and left ventricular shortening rate. But the NYHA classification showed significant difference （ P 〈 0. 05 ）. The risk factors related to the prognosis of pa- tients were preoperative LVESD value ≥6. 0 cm, heart function NYHA classification in grade IV, postoperative un- use of ACEI drugs or β-blockers （ P 〈 0. 05 ）. Conclusion The perioperative mortality is low in patients with val- vular heart disease and giant left ventricle after heart valve replacement surgery. The curative effect is satisfactory, the shape and size of the heart in the medium term have obvious reverse remodeling process, and the cardiac func- tion is also improved. Preoperative LVESD value ≥6.0 cm, heart function NYHA classification in grade IV, post- operative unuse of ACEI drugs or β-blockers are the major risk factors affecting prognosis of patients.