风湿性心脏病合并冠心病行瓣膜置换术对预后的影响

目的探讨风湿性心脏病(简称风心病)行人工瓣膜置换术后早期发生死亡(术后30 d内)与术前合并冠心病的关系。方法收集1996年1月至2004年12月460例风心病人工瓣膜置换术患者的临床资料,按术后是否死亡分为两组,死亡组50例,均术后30 d内发生死亡;对照组从410例未发生死亡的患者中随机选择60例作为对照。其中所选病例均为术中麻醉平稳,手术过程顺利,术后常规对症处理的患者。选择术前临床指标,超声心动图,术前合并症、并发症等指标,用Logistic回归方法分析术前因素与术后死亡发生的关系。结果术前合并冠状动脉病变,心功能分级(NYHA),瓣膜置换同期行冠状动脉搭桥术,左室舒张末内径(LVEDD)(男>75 mm,女>70 mm)是手术早期发生死亡的独立预测因素。结论术前合并冠心病影响术后早期病死率,术前应明确诊断,积极围手术期处理,同期行冠状动脉旁路移植术。

Complicating coronary artery disease for effect of prognosis before cardiac valve replacement of rheumatic heart disease

Objective To investigate the relationship between preoperative complicating coronary artery disease and death after cardiac valve replacement within 30 days in patients with rheumatic heart disease.Methods From january 1996 to december 2004,460 patients who had undergone cardiac valve replacement procedure were reviewed and divided into two groups according to whether death appeared after operation within 30 days.Death group included 50 cases who died after operation within 30 days,control group included 60 cases taken from 410 cases at random who had no death occured on.The clinical dates,indexes of ultrasonocardiography(UCG),preoperative complications and other organs′ and tissues′ complicating disease were selected and the risk factors of death were analysed with Logistic regression method.Results Coronary artery disease,coronary artery bypass grafting(CABG) undergoing cardiac valve replacement,preoperative heart function grade,preoperative left ventricular end-diastolic diameters(men>75 mm,women>70 mm),were independent predictors of postoperative death within 30 days.Conclusion Preoperative complicating coronary artery disease affects early mortality rate after operation.Preoperative definitive diagnosis,effective treatment and CABG for important anoxemic coronary artery are necessary,while more cases review and clinical trials are necessary for evaluation the early and late results of cardiac valve replacement.