心脏瓣膜置换术后早期死亡原因及相关因素分析

目的:探讨心脏瓣膜置换患者术后早期死亡原因及相关危险因素。方法:回顾性总结我院胸心血管外科自2009-06-2012-06行心脏瓣膜置换的425例患者的临床资料,分析术后早期死亡原因及危险因素。结果:术后早期病死率3.52%,生存410例,死亡15例;单因素及多因素Logisitic回归分析提示:低心排综合征(LCOS),多器官功能衰竭(MOF),左室破裂,心功能Ⅳ级,LVEDD≥70mm及CPB转流时间≥180min是影响瓣膜置换患者术后早期死亡的重要危险因素(P0.05)。结论:LCOS、MOF及左室破裂是心脏瓣膜置换患者术后早期导致死亡的主要并发症。心功能Ⅳ级,LVEDD≥70mm及CPB转流时间≥180min可能是心脏瓣膜置换患者术后早期死亡的独立危险因素。     

达芬奇机器人前列腺癌根治术患者生存质量及影响因素

目的分析应用达芬奇机器人行前列腺癌根治术后患者的生存质量及影响因素。方法采用问卷调查法对70例行达芬奇机器人前列腺癌根治术患者医院焦虑及抑郁情况、生存质量、各项指标评分进行调查分析。采用单因素分析和多元线性回归分析对术后生存质量影响因素进行分析。结果术后6个月患者焦虑、抑郁情况显著低于术前(P<0. 05)。术后1个月生存质量评分均显著低于术前(P<0. 05)。术后6个月生存质量评分均显著高于术前及术后1个月(P<0. 05)。术后6个月患者泌尿系统症状、性功能障碍、肠道症状、体重减轻评分均低于术后1个月(P<0. 05)。单因素及多因素分析可知,社会支持、疾病因素、面对生活、焦虑抑郁、经济状况、重返工作岗位与患者的生活质量均相关(P<0. 05)。结论达芬奇机器人前列腺癌根治术远期能达到改善患者生存质量及临床症状的目的,但短期内会出现生存质量下降。     

同期行CABG与HVR对冠心病合并心脏瓣膜病变患者疗效及预后的影响

目的:探讨同期进行冠状动脉旁路移植术(CABG)与心脏瓣膜置换术(HVR)对冠心病合并心脏瓣膜病变患者ICU停留时间、心功能及远期预后的影响。方法:选择我院收治的94例冠心病合并心脏瓣膜病变患者为研究对象,随机均分为CABG与HVR非同期治疗组和同期治疗组,每组47例,对比两组患者术后心功能、术中术后相关指标及5年内生存率,不良反应发生率。结果:术后与非同期治疗组比较,同期治疗组LVEF [(44.23±11.03)%比(49.58±11.39)%]、左心室舒张早期峰值流速比舒张晚期峰值流速(E/A)[(0.87±0.09)比(0.94±0.12)]明显提高,左房内径(LAD)[(39.47±10.16)mm比(34.46±8.72)mm]、左室舒张末期内径(LVEDd)[(58.49±10.65)mm比(53.17±9.13)mm]、左室收缩末期内径(LVESd)[(48.69±8.73)mm比(42.07±8.36)mm]、心胸比(CTR)[(0.66±0.14)比(0.54±0.09)]明显减小,心功能Ⅱ级比例(46.81%比70.21%)明显增加,Ⅲ级比例(34.04%比12.77%)明显降低,升主动脉阻断时间、体外循环时间、呼吸机辅助时间、ICU停留时间、住院时间均明显缩短(P0.05或0.01)。5年后随访,与非同期治疗组比较,同期治疗组心血管不良事件发生率(40.43%比19.15%)明显降低,5年生存率(44.68%比68.08%)明显升高(P均0.05)。结论:冠心病合并心脏瓣膜病变患者同期行CABG与HVR能够显著缩短ICU停留时间等术后观察指标,改善心功能,提高远期生存率,减少不良事件率。     

19mm和21mm St.Jude主动脉瓣膜置换术后长期随访结果比较

应用小直径人造心脏瓣膜行主动脉瓣置换术后可能会导致左心室流出道残余梗阻,引起心肌肥厚,妨碍术后病情康复,并有可能影响术后长期生存率。该文对229例置换19mm或21mm标准St.Jude瓣膜的患者进行了近15年的长期临床随访、研究。     

长期未复发口腔鳞状细胞癌患者术后口腔健康生存质量

目的分析长期未复发口腔鳞状细胞癌(OSCC)患者术后口腔健康生存质量的影响因素。方法回顾性分析84例长期未复发晚期OSCC患者的临床资料,所有患者接受肿瘤根治术联合术后放化疗,术后生存时间超过18个月,选择华盛顿大学生存质量(UWQOL)量表进行调查,采用单因素及多因素Logistic分析长期未复发OSCC患者术后口腔健康生存质量的相关影响因素。结果术后患者疼痛指标评分明显高于术前,而外貌、吞咽、娱乐、咀嚼、活力、肩功能、语言、情绪、焦虑、唾液、味觉及总分值等生存质量指标均明显低于术前(均P0.05);单因素分析得出,年龄、文化程度、焦虑、抑郁情况是长期未复发OSCC患者术后生存质量的影响因素(P0.05);多因素Logistic回归分析得出,文化程度、焦虑、抑郁是影响长期未复发SCC患者术后生存质量的独立危险因素(P0.05)。结论患者年龄、文化程度、焦虑、抑郁情况对长期未复发OSCC患者术后口腔健康生存质量有一定影响,且文化程度、心理状态是影响的独立危险因素。     

老年喉癌患者术后远期疗效及生存质量的影响因素

目的分析老年喉癌患者术后远期疗效及生存质量的影响因素。方法选择136例老年喉癌术后患者,对其进行为期5年随访,分析患者5年生存率,并对可能影响患者5年生存率的因素进行单因素及多因素Logistic回归分析。对术后5年生存患者进行汉化华盛顿生存质量问卷(UW-QOL)访谈式自评法进行调查,并对可能影响患者生存质量的各因素进行单因素及多因素Logistic回归分析。结果136例老年喉癌患者,术后随访5年生存率为59.56%(81/136)。对可能影响患者术后远期疗效因素进行单因素及多因素Logistic回归分析,结果显示,TNM分期、淋巴结转移、原发部位、治疗方式进入Logistic回归模型。对可能影响患者术后远期生存质量各因素进行单因素及多因素Logistic回归分析,结果显示,TNM分期及年龄进入Logistic回归模型。结论应对影响老年喉癌患者术后远期疗效的重要因素给予足够的重视,拟定适宜的治疗方案,以期提高患者生存率及生活质量。     

瓣膜性心脏病伴永久性心房颤动患者术中消融疗效的分析

目的:明确在对瓣膜性心脏病伴永久性心房颤动(房颤)患者的手术中进行房颤消融的有效性,以及影响消融成功率的主要因素.方法:从2005-09至2007-12,对57例患者施行了瓣膜手术,并在术中进行了房颤消融.术前测量患者的左心室射血分数、左心室收缩末期容积、左心室舒张末期容积、左心房直径、肺动脉压,并与年龄、性别、主动脉阻断时间.术后进行随访,分析影响消融成功的关键因素.结果:全组围手术期死亡2例,随访2～24个月,保持窦性心律者为39例(70.9%,n=55).结论:在瓣膜手术中施行房颤消融安全、有效,影响消融成功率的唯一因素为左心房大小.     

瓣膜置换手术的非贫血患者术中异体血输注的影响因素分析

目的:心脏手术术中输血是导致围术期不良预后的重要因素之一,分析133例行瓣膜置换的非贫血患者术中输血的影响因素,为心脏瓣膜手术围术期合理输血提供理论依据.方法:纳入2015年1月—2017年12月于我院行瓣膜置换手术的133例患者,按术中是否输注异体血分为异体输血组(51例)和非异体输血组(82例),比较两组患者的临床...     

心脏瓣膜置换术后早期抗凝影响因素分析

对机械瓣膜置换术后早期抗凝影响因素进行回顾性分析，发现体质量与心功能对华法林维持剂量有显著的影响，其中体质量的影响最为明显。认为可利用瓣膜置换患者的体重与心功能指导术后早期抗凝治疗。     

风湿性心脏瓣膜替换术后远期疗效观察

目的:分析风湿性心脏病瓣膜替换术后远期疗效及其影响因素。方法:我院1980年-2004年施行心脏瓣膜替换613例,早期死亡30例。术后获访495例,获访时间为2700病人年, 平均5．45病人年。结果:晚期死亡37例。晚期死亡率1．61％病人年。机械瓣和生物瓣晚期死亡率分别为1．10％和6．10％病人年,15 年生存率分别为89．3％和43．1％。结论:影响心脏瓣膜替换晚期疗效主要因素为抗凝不当、术前心功能、年龄和心房颤动。机械瓣替换术晚期死亡原因主要为抗凝有关并发症、心室颤动、细菌性心内膜炎和心力衰竭,而生物瓣膜替换术晚期死亡原因则为生物瓣衰败。     

389例风湿性心脏瓣膜替换术后远期疗效观察

目的 :分析风湿性心脏病瓣膜置换术后远期疗效及其影响因素。方法 :1980年至 2 0 0 0年施行心脏瓣膜置换 4 33例 ,早期死亡 2 7例。术后获访 389例 ,获访时间为 2 16 8病人年 ,平均 5 92病人年。结果 :晚期死亡 35例。晚期死亡率为 1 6 1%病人年。机械瓣和生物瓣晚期死亡率分别为 1 17%和6 10 %病人年 ,15年生存率分别为 89 3%和 4 3 1%。结论 :影响心脏瓣膜置换晚期疗效的主要因素为术前心功、年龄和心房纤颤。机械瓣置换术后晚期死亡原因主要与抗凝有关并发症、心室纤颤、细菌性心内膜炎和心衰有关 ,而生物瓣膜置换术后死亡原因则为生物瓣衰败     

炎症相关基因多态性与心脏瓣膜置换术后华法林治疗疗效的相关性研究

目的：本研究旨在研究阐明炎性基因IL-17的多态现象与心脏瓣膜置换术后华法林治疗的关系。方法：纳入我院行心脏瓣膜置换术采用华法林治疗的患者96例作为观察组,另外纳入未采用华法林治疗的生物瓣置换术患者78例作为对照组,采用基因测序的方法确定单核苷酸多态性的等位基因,分析两组患者的基因型与临床特点,探讨分析子心脏瓣膜置换术后华法林治疗与不同的IL-17基因型之间的关系;采用Logistic回归分析基因型与心脏瓣膜置换术后危险因素之间的相关性;运用Kaplan-Meier的生存曲线对携带IL-17 rs763780及rs2275913两种基因型患者的生存与疗效情况进行分析。结果：IL-17基因型在两组的基因型分布是不相同的,通过多因素的Logistic回归分析显示rs763780及rs2275913两种基因型是心脏瓣膜置换术后并发症发生的危险因素;术后并发症发生的患者rs2275913基因型的比例要高于未出现并发症患者,治疗疗效及生存分析方面,携带IL-17rs2275913基因型的患者生存时间要短于携带rs763780基因型,两组比较差异具有统计学意义,IL-17rs2275913基因型表达的高低与预后有着一定的相关性。结论：IL-17的G等位基因是心脏瓣膜置换术后并发症发生的危险因素,rs2275913基因型与子心脏瓣膜置换治疗及预后有着相关性,可作为心脏瓣膜置换术后危险因素。     

重危瓣膜病变合并巨大心脏的外科治疗

目的:报道181例重危瓣膜病变合并巨大心脏的外科治疗体会。方法:回顾性分析181例瓣膜外科病例中合并巨大心脏临床资料,男性76例,女性105例,年龄15～57岁,平均(45.7±15.2)岁。分为2组:巨大左心房(GLA)组84例,左心房内径(LAD)70～150mm,平均(80.3±17.5)mm;巨大左心室(GLV)组97例,左心室舒张末内径(LVEDD)70～112mm,平均(79.4±12.7)mm。患者全部行瓣膜置换术,其中GLA组行主动脉瓣与二尖瓣双瓣膜置换术12例,二尖瓣置换术72例,同期行三尖瓣环缩成形术42例,左心房血栓清出13例;84例均作左心房折叠术。GLV组行主动脉瓣置换术38例,主动脉瓣与二尖瓣双瓣膜置换术27例,二尖瓣置换术32例,二尖瓣置换术均保留全部或部分瓣膜和瓣下结构,同期行三尖瓣环缩成形术18例,左心房血栓清出4例,左心房折叠术21例。结果:手术早期死亡率GLV组和GLA组分别为9.3%和6.0%,GLV组明显高于GLA组(P<0.05);死亡原因GLV组以室性心律紊乱为主(55.6%),明显高于GLA组(P<0.05);GLA组以呼吸衰竭为主。术后1个月超声心动图显示,GLA组LAD平均(60.1±12.1)mm,GLV组LVEDD平均(56.6±16.1)mm,较术前明显缩小(P<0.01)。心功能恢复良好。结论:瓣膜置换同期左心房折叠术有利于改善合并巨大左心房的术后恢复;保留二尖瓣瓣膜及瓣下结构有利于合并巨大左心室病例的恢复。     

Determinants of health-related quality of life after aortic valve replacement in six-month survivors of intervention

BACKGROUND AND AIM OF THE STUDY: Although several determinants of survival after aortic valve replacement (AVR) have been identified, current knowledge regarding factors influencing the postoperative quality of life (QoL) is poor. The study aim was to evaluate health-related QoL (using Medical Outcome Study Short Form-36) in six-month survivors after AVR, and to determine predictors of outcome. METHODS: All patients undergoing heart valve surgery at the authors' hospital between 1992 and May 1999 were included. Data from 201 patients (119 males, 82 females; mean age 66.6 years) after AVR were obtained. The mean observation period was 42.5 months. RESULTS: Patients in preoperative NYHA classes I and II had a postoperative QoL comparable to that of the general population, while subjects in NYHA classes III and IV scored significantly lower. Multivariate analysis identified four independent predictors (preoperative NYHA class, diabetes mellitus, prosthetic valve type, sternal complications) for the Physical component score. NYHA class, atrial fibrillation, sternal complications and type of valvular heart disease were predictors for the Mental component score. No correlation was found between preoperative left ventricular function or size, pre-existing coronary artery disease or prior myocardial infarction and the postoperative QoL. CONCLUSION: Notably, preoperative aortic stenosis was identified as a strong and independent predictor of the postoperative QoL in six-month survivors after AVR. This effect was independent of left ventricular size and function. These findings support the proposal that patients with aortic stenosis should be operated on at an earlier stage, if possible before they develop symptoms.     

Surgical outcomes of hepatocellular carcinoma invading hepatocaval conlfuence

BACKGROUND: Combined liver and inferior vena cava (IVC) resection followed by IVC and/or hepatic vein reconstruc-tion (HVR) is a curative operation for selected patients with hepatocellular carcinoma (HCC) invading the hepatocaval conlfuence. The present study aimed to elucidate the prog-nostic factors for patients with HCC invading the hepatocaval conlfuence.
METHODS: Forty-two consecutive patients underwent hepa-tectomy, combined with IVC replacement and/or HVR for HCC between January 2009 and December 2014 were included in this study. The cases were divided into three groups based on the surgical approaches of HVR: group 1 (n=13), tumor in-vaded the hepatocaval conlfuence but with one or two hepatic veins intact in the residual liver, thus only the replacement of IVC, not HVR; group 2 (n=23), the hepatic vein of the residual liver was also partially invaded, and the hepatic vein defect was repaired with patches locally; group 3 (n=6), three hepatic veins at the hepatocaval conlfuence were inifltrated, and the hepatic vein remnant was re-implanted onto the side of the tube graft. The patient characteristics, intra- and postopera-tive results, and long-term overall survival were compared among the three groups. The survival-related factors were analyzed by univariate and multivariate analysis.
RESULTS: The group 1 had higher preoperative alpha-fetopro-tein level (P<0.001), shorter operation time, hepatic ischemic time and hospital stay compared with groups 2 and 3 (P<0.05). The 1-, 3-, and 4-year overall survival rates of group 1 were 84.6%, 23.1% and 23.1%, respectively; group 2 were 78.3%, 8.7% and 8.7% respectively and group 3 were 83.3%, 0 and 0, respectively. The multivariate analysis showed that the inde-pendent poor prognostic factors of overall survival were pre-operative higher HBV DNA level (≥103 copies/mL;P=0.001), tumor size (≥9 cm;P<0.0001), age (≥60 years;P=0.010) and underwent HVR (P<0.0001).
CONCLUSIONS: Patients with reconstructing hepatic vein with patches locally (group 2) or to the artiifcial graft (group 3) had worse long-term survival than those without HVR (group 1). HVR was one of the unfavorable prognostic factors of overall survival.     

老年癌症患者生存质量的多因素分析

目的分析和探讨老年癌症患者的生存质量及影响因素。方法对福州市鼓楼区１１６例老年癌症患者的生存状况进行流行病学调查；采用因子分析、逐步回归分析和典型相关分析方法对调查结果进行分析。结果与描述生存质量的典型变量Ｖ有较大相关系数的变量为：年龄、职业、生存时间、手术、化疗、中草药、家庭护理条件。结论老年癌症患者的生存质量主要受上述因素的影响，改善老年人的心理状态及增加其社会交往能力，有利于癌症患者的康复     

Long-term results after aortic valve replacement in patients with congestive heart failure. Homografts vs prosthetic valves.

OBJECTIVES: The aim of this study was to assess the influence of valve substitute (homograft vs prosthetic valve) on the long-term survival and late valve-related complication rates following aortic valve replacement in patients with aortic valve disease and congestive heart failure. BACKGROUND: The effect of choice of valve substitute on outcome after aortic valve replacement in patients with pre-operative heart failure is unknown. The superior haemodynamic profile of homografts may be of particular benefit. METHODS: We retrospectively analysed pre-operative, operative and follow-up data on 518 adults in functional classes III and IV, who, over the 25 years 1969-1993, had their initial aortic valve replacement at Harefield hospital. Follow-up conducted during 1996 to April 1997 and totalling 4439 patient-years was 96.1% complete. Using multivariate analysis, independent risk factors for different complications and mortality were defined. RESULTS: Overall 5-, 10- and 20-year survival was 80+/-2%, 62+/-2% and 30+/-3%, respectively, with no significant difference between valve types. However, homografts (n=381) independently reduced the rate of serious complications and cardiac death, whereas mechanical valves were an independent adverse risk factor for late mortality. The rates of anticoagulant-related bleeding and thromboembolism were increased by mechanical valves, whereas primary tissue failure was the main complication of homografts. CONCLUSIONS: Long-term outcome of homograft aortic valve replacement in patients with congestive heart failure is acceptable, with a reduced rate of serious complications and cardiac death. Further improvements would be expected if the rate of primary tissue failure could be reduced.     

Exaggerated initial response to warfarin following heart valve replacement.

The response to initiation of oral anticoagulants at a usual dose of 5 mg of warfarin has been retrospectively evaluated in patients following heart valve replacement (HVR). Patients starting oral anticoagulants after HVR have a lower target International Normalized Ratio (INR) (1.5 to 2.6) until the pacing wires are removed after operation. The mean daily doses and INR responses after HVR and nonsurgical patients were retrospectively compared during the first 5 days of warfarin treatment. In a subset from both groups, the mean dose of warfarin was correlated with age, body weight, and albumin levels. Eighty-four HVR and 32 nonsurgical patients were studied. The mean daily warfarin dosage was 3.29 +/- 1.29 mg after HVR and 4.96 +/- 1.76 mg in controls (p <0.001), and the mean INRs 2.08 +/- 0.60 and 1.60 +/- 0.54, respectively (p <0.001). Of the HVR patients and controls, 48.8% and 21.8%, respectively, exceeded the upper level of the targeted range (p = 0.014), 86.9% and 40.6% had the dose reduced after the first 5 mg (p <0.001), and 54.7% and 28.1%, respectively, had warfarin withheld for at least 1 day (p = 0.015). Thirty-nine patients were included in the subset analysis. Patients with serum albumin levels <35 g/L required significantly less warfarin (3.84 mg/day) than patients with levels > or =35 g/L (5.37 mg/day; p <0.05). Thus, patients starting oral anticoagulation after HVR are significantly more sensitive to warfarin than nonsurgical patients. Patients with serum albumin levels below the normal values require less warfarin than patients with normal values during the initial phase of treatment.     

Quality of life and mechanical heart valve sound

Most currently used mechanical heart valve prostheses generate a distinct metallic sound at closure. Since this sound is often well audible to many patients it can significantly affect their quality of life after heart valve replacement. In this study of surviving patients after heart valve replacement with three types of Bj?rk-Shiley valves (Shiley Inc., Irvine, Ca) one third of the patients claimed that they were in certain situations disturbed by the sound. Several factors were found to be of importance for the perception of mechanical heart valve noise, including age, sex, location of valve, configuration of the thorax, hearing ability and environmental background noise. Preoperative patient information can be of vital importance to avoid postoperative adverse patient reactions.