成人主动脉瓣置换 927 例回顾性分析

目的 探讨近20年来中国大陆主动脉瓣病变的病因构成、变迁及成人主动脉瓣置换手术的早期预后。 方法 回顾性分析1990年1月至2009年12月第二军医大学长海医院927例成人主动脉瓣置换术患者的临床资料。 结果 先天性和退行性病变是近年来成人主动脉瓣置换术的主要病因。风湿性和感染性病变比例逐渐下降，而退行性和先天性病变比例不断上升。后10年内患者的术后呼吸机辅助时间、术后ICU停留时间及术后住院时间均较前10年明显缩短（P<0.05）。927例患者中44例发生在院死亡，总在院病死率4.7%；男女性病死率差异无统计学意义；近15年内患者手术病死率下降，明显低于最初5年（P<0.05）。 结论 国人主动脉瓣疾病的病因近20年来发生明显变化；成人主动脉瓣置换术后在院病死率较前下降。

Aortic valve replacement in adults: a retrospective study of 927 cases.

Objective To investigate the etiological spectrum of aortic valve diseases and the early prognosis of Chinese adults undergoing aortic valve replacement during 1990-2009. Methods The clinical data of 927 patients, who received aortic valve replacement in Changhai Hospital during 1990-2009, were retrospectively analyzed. Results It was showed that the major causes of the aortic valve replacement included congenital disease and degenerative conditions, with the proportions of rheumatic and infectious etiologies gradually decreased while those of degenerative and congenital etiologies kept increasing. The latter ten years witnessed a significantly decreased duration of postoperative ventilation, time in the intensive care unit (ICU) and length of postoperative hospital stay compared with those of the first ten years (P<0.05). The overall in-hospital mortality was 4.7% (44 of 927 patients) in our study, showing no gender difference. The in-hospital mortality in the latter 15 years was significantly lower than that of the first 5 years (P<0.05). Conclusion The causes of aortic valve disease in China have changed over the past 20 years, and the in-hospital mortality of adults undergoing aortic valve replacement has decreased than before.