外科治疗冠心病合并中度缺血性二尖瓣反流术后早期死亡危险因素分析

Risk factors for early death after surgical treatment of coronary heart disease complicated with moderate ischemic mitral regurgitation

目的:分析外科治疗冠心病合并中度缺血性二尖瓣反流患者术后早期死亡的危险因素,探讨是否同期处理二尖瓣是否降低术后早期死亡率,从而优化围术期管理。方法:回顾性分析北京安贞医院2008年1月至2020年1月收治的诊断为冠心病合并中度缺血性二尖瓣反流并行外科治疗患者的临床资料,根据术后30d内是否死亡,将患者分为早期存活组与早期死亡组,采用单因素分析和二元Logistic多因素回归分析,确定影响外科治疗冠心病合并中度缺血性二尖瓣反流患者术后早期死亡的危险因素。结果:本研究共纳入冠心病合并中度缺血性二尖瓣反流并行外科治疗的1185例患者,术后早期总死亡率为4.8%(57/1185)。在调整术前危险因素后,是否行二尖瓣成形术不是影响死亡的危险因素(OR=0.668,95%CI:0.262~1.700,P=0.397)。二元Logistics多因素回归分析结果显示:女性(OR=3.950,95%CI:2.121~7.357,P<0.001)、近3个月心肌梗死(OR=2.319,95%CI:1.287~4.176,P=0.005)、高血压病史(OR=2.346,95%CI:1.227~4.488,P=0.010)、慢性阻塞性肺病(OR=4.739,95%CI:1.525~14.728,P=0.007)、肌酐水平(OR=1.004,95%CI:1.001~1.006,P=0.006)、LVEF(OR=0.944,95%CI:0.916~0.973,P<0.001)、手术时长(OR=1.692,95%CI:1.423~2.013,P<0.001)是患者术后早期死亡的独立危险因素。结论:是否同期行二尖瓣手术不是影响中度IMR患者早期死亡的危险因素,女性、近3个月心肌梗死、高血压病史、慢阻塞性肺病、肌酐水平、LVEF、手术时长是术后早期死亡的危险因素。

Objective:To analyze the risk factors of early postoperative death in patients with coronary heart disease complicated with moderate ischemic mitral regurgitation,and to explore whether simultaneous treatment of mitral valve can reduce early postoperative mortality,so as to optimize perioperative management.Methods:The clinical data of patients diagnosed with coronary heart disease complicated with moderate ischemic mitral regurgitation and treated by surgery from January 2008 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed.According to whether they died within 30 days after surgery,the patients were divided into early survival group and early death group,using univariate analysis and binary analysis Logistic multivariate regression analysis was conducted to determine the risk factors for early postoperative death in patients with coronary heart disease complicated with moderate ischemic mitral regurgitation.Results:A total of 1185 patients with coronary heart disease complicated with moderate ischemic mitral regurgitation and surgical treatment were included in this study,and the early postoperative mortality was 4.8%(57/1185).After adjusting for preoperative risk factors,whether mitral valvuloplasty was performed was not an independent risk factor for death(OR=0.668,95%CI:0.262-1.700,P=0.397)The results of binary Logistics multi-factor regression analysis showed that female(OR=3.950,95%CI:2.121-7.357,P<0.001)myocardial infarction in recent 3 months(OR=2.319,95%CI:1.287-4.176,P=0.005)history of hypertension(OR=2.346,95%CI:1.227-4.488,P=0.010)Creatinine level in chronic obstructive pulmonary disease(OR=4.739,95%CI:1.525-14.728,P=0.007)(OR=1.004,95%CI:1.001-1.006,P=0.006)LVEF(OR=0.944,95%CI:0.916-0.973,P<0.001)operative duration(OR=1.692,95%CI:1.423-2.013,P<0.001).Conclusions:Concurrent mitral valve surgery was not an independent risk factor for early death in patients with moderate IMR,and the female history of hypertension with myocardial infarction in recent 3 months chronic obstructive pulmonary disease creatinine level and left ventricular ejection fraction was an independent key factor for early postoperative death.