老年退行性心脏瓣膜病变患者行主动脉瓣膜置换术后1年随访状态

Status of elderly patients with degenerative heart valvular disease at one year after aortic valve replacement

目的研究老年退行性心脏瓣膜病变(SDHVD)患者行主动脉瓣膜置换术后生活质量变化并分析其相关影响因素。方法将2020年4月至2022年4月在南京医科大学第一附属医院收治的140例SDHVD患者纳为研究对象,纳入患者均为单纯主动脉瓣钙化,因出现典型症状行主动脉瓣置换术(AVR),分别在其术前及术后1年回院复诊时,采用简明健康状况量表(SF-36)评估其生活质量,分析AVR在改善患者生活质量中的价值。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、方差分析及χ^(2)检验。采用多元线性回归模型分析影响患者术后生活质量的相关因素。结果排除围术期死亡者、随访期失访者及死亡者后,140例行AVR治疗的老年SDHVD患者中有118例获得完整随访资料。术后1年,患者生活质量SF-36量表中生理功能、生理职能、躯体疼痛、总体健康、生命力维度得分以及量表总得分均较其术前上升,但依旧低于常模水平,差异均有统计学意义(P<0.05)。多元线性回归分析提示,体质量指数(BMI)、平均跨瓣膜压差对老年SDHVD患者术后1年生活质量有负向预测作用(β=-0.374、-0.153;均P<0.001);规律运动、术前左心室射血分数(LVEF)以及主动脉瓣有效瓣口面积指数(EOAI)对患者术后1年生活质量有正向预测作用(β=0.177、0.276、0.311;均P<0.001),其可共同解释患者生活质量41.70%的变异度。结论老年SDHVD患者AVR术后1年生活质量整体较其术前提高,但依旧低于常模水平,而BMI、规律运动、术前LVEF、平均跨瓣膜压差以及EOAI是影响老年SDHVD患者AVR术后1年生活质量的相关因素。

Objective To study the changes of quality of life in patients with senile degenerative heart valvular disease(SDHVD)after aortic valve replacement and analyze the related influencing factors.Methods Totally 140 patients with SDHVD admitted to the First Affiliated Hospital of Nanjing Medical University from April 2020 to April 2022 were enrolled as the study subjects,and they had simple aortic valve calcification and underwent aortic valve replacement(AVR)due to typical symptoms.Short-form-36 health survey(SF-36)was used to evaluate the quality of life before surgery and at re-visit at one year after surgery,and the value of AVR on improving the quality of life of patients was analyzed.SPSS statistics 22.0 was used for statistical analysis.Data comparison between two groups was perfomed using t test,analysis of variance orχ^(2) test depending on data type.Multivariate linear regression model was applied to analyze the related factors affecting the postoperative quality of life of patients.Results After excluding deaths during perioperative period and loss of follow-up and deaths during follow-up period,118 of 140 elderly patients with SDHVD who underwent AVR had complete follow-up data.At one year after surgery,the scores of physical function,role physical,bodily pain,general health and vitality and total score of SF-36 scale were increased compared with those before surgery,but were still lower than the norms(P<0.05).Multivariate linear regression analysis indicated that body mass index(BMI)and mean transvalvular pressure difference had negative predictive effects on quality of life at one year after surgery in elderly patients with SDHVD(β=-0.374,-0.153;both P<0.001);regular exercise,preoperative left ventricular ejection fraction(LVEF)and effective orifice area index(EOAI)index had positive predictive effects on quality of life of patients at one year after surgery(β=0.177,0.276,0.311;all P<0.001),witch could jointly explain 41.70%of the variance of quality of life of patients.Conclusion The quality of life at one year after AVR in elderly SDHVD patients is generally higher than that before AVR,but it is still lower than the norm level.BMI,regular exercise,preoperative LVEF,mean transvalvular pressure difference and EOAI are related factors affecting the quality of life at one year after AVR in elderly SDHVD patients.