左心瓣膜疾病相关性肺动脉高压的临床分析

Clinical analysis of pulmonary artery hypertension due to left heart valve disease

目的观察和分析左心瓣膜疾病相关性肺高压(pulmonary artery hypertension due to left heart valve diseases,LHD-PAH)的临床特征、危险因素和对临床结局的影响。方法纳入2012年1月至2015年2 月在我科行体外循环心脏瓣膜手术的患者。以超声心动图为主要诊断标准,LHD-PAH采用三尖瓣反流法估算的肺动脉收缩压值进行诊断。收集患者的临床信息进行统计分析。结果共纳入958例患者,其中合并LHD-PAH的患者共391例,占40.8%。通过单因素分析及多因素Logistic回归分析,我们发现射血分数<30%(OR=4.490,95%CI 1.920-10.499,P<0.01)、心房颤动(OR=9.654,95%CI 3.214-21.411 ,P<0.01)、左心房血栓(OR=3.991,95%CI 2.946-5.406,P<0.01)为LHD-PAH的独立危险因素。一旦左心瓣膜疾病患者出现 LHD-PAH后,其体外循环转流时间将会显著高于非LHD-PAH患者(P<0.01),然而主动脉阻断时间则无显著差异(P=0.331)o而且,LHD-PAH的出现还会增加患者的机械通气时间、ICU留治时间、总住院日以及病死率(P<0.01)。结论LHD-PAH在临床中发生率较高,患者临床结局不良,射血分数<30%、心房颤动和左心房血栓是其独立危险因素。

Objective To describe the clinical characteristics, risk factors and outcomes of pulmonary artery hypertension due to left heart valve diseases (LDH-PAH). Methods 958 patients who have undergone valve surgeries in our department from January 2012 to February 2015 were included in the research. Diagnosis was confirmed mainly by echocardiography. Pulmonary artery hypertension was diagnosed by pulmonary artery systolic blood pressure estimated by using tricuspid regurgitation method. Clinical information of patients was collected for statistical analysis. Results Among the 958 patients, 391 patients were diagnosed as LDH-PAH, accounting for 40.8%. By using both univariate analysis and multiple logistic regression, LVEF<30%(OR=4.490, 95%CI 1.920-10.499, PO.Ol), atrial fibrillation (OR=9.654, 95%CI 3.214-21.411, P<0.01) and left atrial thrombus (OR=3.991, 95%CI 2.946-5.406, P<0.01) were found to be independent risk factors for LDH-PAH. Once PAH occurred in patients with valvular diseases, the cardiopulmonary bypass time could significantly increase(P<0.01), while there was no difference in aortic clamping time(P=0.331). Furthermore, LDH-PAH was closely related to higher mortality as well as longer intensive care unit stay time, mechanical ventilation time and hospitalization time (P<0.01). Conclusion LDH-PAH could often occur in patients with valvular and be associated with poor prognosis. EF<30%, atrial fibrillation and left atrial thrombus are independent risk factors for pulmonary hypertension due to left heart valve diseases.