不同瓣膜类型对老年瓣膜性心脏病患者临床获益的影响

Influence of different kinds of valve types on clinical benefits of elderly patients with valvular heart disease

目的探讨机械瓣膜和生物瓣膜对老年瓣膜性心脏病患者临床获益的影响。方法回顾性分析我院2008~2014年行瓣膜置换术老年瓣膜性心脏病280例患者的临床资料,针对行生物瓣膜置换(A组)和机械瓣膜置换(B组)患者行倾向性评分匹配,共匹配出96对:A组男43例、女53例,年龄(64.41±6.52)岁;B组男44例、女52例,年龄(64.07±6.20)岁。结果B组皮肤黏膜出血率显著高于A组(P<0.05)。A、B两组术后30 d内死亡率、全因死亡率、再次住院率、再次瓣膜置换率、合并心房扑动/心房颤动比例、药物使用情况、脑梗死发生率、脑出血发生率、新发外周血管栓塞发生率、脏器出血率、心功能(NYHA)分级、患者随访累积生存率(P=0.63)、无血栓/出血随访累积生存率(P=0.75)差异无统计学意义(P>0.05)。结论机械瓣膜和生物瓣膜置换治疗老年瓣膜性心脏病可获得相近临床获益,均具有临床应用价值。

Objective To investigate the influence of mechanical and biological valves on clinical benefits of elderly patients with valvular heart disease.Methods We retrospectively analyzed the clinical data of 280 elderly patients with valvular heart disease treated by valve replacement between 2008 and 2014 year.The patients were divided into two groups by tendency score matching including a group A with biological valves and a group B with mechanical valves.Finally,there were 96 patients in each group.There were 43 males and 53 females at age of 64.41±6.52 years in the group A,44 males and 52 females at age of 64.07±6.20 years in the group B.Results The bleeding rate of skin and mucosa of the group B was significantly higher than that of the group A(P<0.05).There was no statistical difference in mortality within 30 days after operation,all-cause mortality,re-hospitalization rate,re-valve replacement rate,combined atrial flutter/atrial fibrillation ratio,drug use,incidence of cerebral infarction,cerebral hemorrhage,new peripheral vascular embolism and visceral hemorrhage,heart function(NYHA)classification,the cumulative survival rate of all the patients during follow-up(P=0.63),or the cumulative survival rate of the patients with no thrombus/hemorrhage(P=0.75)between the two groups(P>0.05).Conclusion Mechanical valve replacement and bioprosthetic valve replacement in the treatment of valvular heart disease in the elderly can achieve similar clinical benefits and both have clinical application value.