三尖瓣置换术后早期与远期临床效果及影响术后机械通气时间延长的危险因素分析

The Early and Long-term Outcome of Tricuspid Valve Replacement and Risk Factors Related to Prolonged Postoperative Mechanical Ventilation Time

目的:了解三尖瓣置换术后早期与远期效果,并分析瓣膜置换术后机械通气时间延长的危险因素。方法:回顾并总结我院2007年1月至2015年12月96例成人(≥18岁)患者三尖瓣置换术后临床资料,平均年龄(46.5±9.3)岁,其中风湿性心脏瓣膜病患者66例(68.8%)。分析患者三尖瓣置换术后早期(≤30天)死亡率及并发症发生情况,并进一步应用Logistic回归方程探索与术后机械通气时间延长(≥48 h)的相关危险因素。应用Kaplan-Meier方法估算远期生存率。结果:96例三尖瓣置换患者术后早期死亡7例(7.3%),其中死于低心排综合征4例,肺部感染导致的多器官功能衰竭2例,心室颤动1例;29例(30.2%)患者发生围术期机械通气时间延长。术前存在腹水、二次手术、体外循环时间≥120 min是三尖瓣置换术后机械通气时间延长的相关危险因素(P均<0.05)。术后随访成功64例(71.9%),平均随访(45.3±27.1)个月期间,5例(7.8%)患者死亡,包括反复发生的心力衰竭3例,二次手术后并发多器官功能衰竭1例,脑出血1例。Kaplan-Meier方法估算术后2年、4年及8年患者生存率分别为(90.5±3.0)%、(87.4±3.7)%及(81.5±6.7)%。结论:三尖瓣置换术后早期死亡率为7.3%,相对满意。术前存在腹水、二次手术和体外循环时间≥120 min,增加术后患者机械通气时间延长风险。

Objectives:To evaluate the early and long-term outcomes of tricuspid valve replacement and analyze the related risk factors of prolonged mechanical ventilation post operation.Methods:From January 2007 to December 2015,tricuspid valve replacement was performed in 96 patients at our institution.The mean age was(46.5±9.3)years and 73 patients were female.The main cause of tricuspid disease was rheumatic valvular disease(n=66).71 cases received mechanical valve replacement and the other 25 cases received biological valve replacement.Early(≤30 days)and long-term outcome were evaluated,risk factors related to prolonged mechanical ventilation post operation were analyzed by logistic regression.Results:The early mortality of tricuspid valve replacement was 7.3%(7/96).The cause of death was 4 deaths due to low cardiac output syndrome,2 deaths due to multiple organ failure caused by pulmonary infection and 1 death due to ventricular fibrillation.This study found that 30.2%(29/96)patients experienced the prolonged period of mechanical ventilation in the perioperative period.Preoperative ascites,re-operation,and extracorporeal circulation time≥120 min were the risk factors for prolonged mechanical ventilation after tricuspid valve replacement.Follow-up data were available in 64 cases(71.9%),and the average follow-up time was(45.3±27.1)months(6-104 months).Five patients died during the follow-up period.The cause of death included 3 cases of heart failure,1 case of multiple organ failure after second operation and 1 case of cerebral hemorrhage.The 2-year,4-year and 8-year survival rate was(90.5±3.0)%,(87.4±3.7)%and(81.5±6.7)%,respectively.Conclusions:This study results show that the early and long-term outcome of tricuspid valve replacement is satisfactory and mortality rate post operation is low.Preoperative ascites,re-operation and extracorporeal circulation time≥120 min could lead to a significant prolonged mechanical ventilation time post operation.