左室射血分数<40%主动脉瓣关闭不全患者术后心功能恢复影响因素分析

Analysis of influencing factors of postoperative cardiac function recovery in patients with aortic insufficiency with left ventricular ejection fraction less than 40%

目的探讨主动脉瓣关闭不全(AI)合并左室射血分数(LVEF)<40%的患者瓣膜手术后心功能恢复的影响因素。方法选取自2010年1月至2018年12月北部战区总医院收治的左室收缩功能减低(LVEF<0.40,Simpson法)的AI并行单纯主动脉瓣置换(AVR)的99例患者为研究对象。根据瓣膜术后6个月时左室收缩功能是否恢复(LVEF≥0.50,Simpson法)将患者分为恢复组(n=52,LVEF≥0.50,Simpson法)与未恢复组(n=47,LVEF<0.50 Simpson法)。记录并比较两组患者术前的基本临床资料及超声数据。应用χ^(2)检验分析左室收缩末期容积(LVESV)、三尖瓣口舒张早期前向血流峰速/三尖瓣瓣环侧壁舒张早期峰速(Et/Et′)与心功能减低的AVR术后LVEF不能恢复的关系。结果单因素分析发现,两组患者的舒张压、左房前后径(LAD)、左室舒张末期容积(LVEDV)、LVESV、Et/Et′比较,差异有统计学意义(P<0.05)。多因素分析发现,Et/Et′较高(P>0.001)和/或LVESV较大(P>0.016)是AVR术后LVEF不易恢复的危险因素。术前三尖瓣Et/Et′≥7.5和/或LVESV≥155.0 ml且LVEF<0.40的AI患者术后心功能更不易恢复。结论术前左室收缩末期内径较大和/或右室舒张功能出现减低是LVEF<0.40的AI患者术后心功能不易恢复的危险因素。

Objective To investigate the influencing factors of cardiac function recovery in patients with aortic insufficiency(AI)with left ventricular ejection fraction(LVEF)<40%after valve surgery.Methods A total of 99 patients with reduced left ventricular systolic function(LVEF<0.40,Simpson method)treated with AI and simple aortic valve replacement(AVR)were selected from January 2010 to December 2018 in General Hospital of Northern Theater Command.Patients were divided into recovery group(n=52,LVEF≥0.50,Simpson)and non-recovery group(n=47,LVEF<0.50,Simpson)according to whether left ventricular systolic function was restored at 6 months after valvular surgery.Preoperative basic clinical data and ultrasound data were recorded and compared between the two groups.Theχ2 test was used to analyze the relationship between the left ventricular end-systolic volume(LVESV),early diastolic anterior flow peak velocity of tricuspid valve orifice/early diastolic peak velocity of lateral wall of tricuspid valve ring(Et/Et′)and non-recovery of LVEF after AVR with reduced cardiac function.Results Univariate analysis showed that there were statistically significant differences in diastolic blood pressure,left anterior posterior diameter(LAD),left ventricular end diastolic volume(LVEDV),LVESV and Et/Et′between 2 groups(P<0.05).Multivariate analysis showed that high Et/Et′(P>0.001)and/or high LVESV(P>0.016)were risk factors for LVEF recovery after AVR.AI patients with tricuspid Et/Et′≥7.5 and/or LVESV≥155.0 ml and LVEF<0.40 were less likely to recover cardiac function after surgery.Conclusion Large left ventricular end systolic diameter and/or decreased right ventricular diastolic function before operation are the risk factors for cardiac function recovery in patients with aortic insufficiency with LVEF<0.40.