人工心脏瓣膜置换术后心内血栓形成危险因素的一年随访研究

目的 探讨人工心脏瓣膜置换术后心内血栓形成的危险因素.方法 回顾性分析2005年1月至2009年4月690例瓣膜置换手术者中在住院期间或1年内随访发现心内血栓形成的29例患者,其中男性11例,女性18例;年龄12～70岁,平均48岁.单因素和Logistic回归多因素分析影响瓣膜置换术后心内血栓形成的危险因素.结果 单因素分析显示,21个独立因素中共有7个因素即生物瓣置换、阿司匹林抗凝、二尖瓣置换、心房颤动、术前左心房内径、术后左心房内径、术后纤维蛋白原水平与术后心内血栓形成有关(P<0.05).多因素分析显示,二尖瓣置换(OR=9.815,P<0.05)、心房颤动(OR=5.267,P<0.05)、术前左心房增大(OR=4.529,P<0.05)是术后心内血栓形成的独立危险因素.结论 人工瓣膜置换术后心内血栓形成与二尖瓣置换、心房颤动、术前左心房增大有相关性.应重视生物瓣置换术后的抗凝.

Analysis on the risk factors of intracardial thrombus after prosthetic valve replacement: a 1-year follow-up study

Objective To analysis the risk factors predicting intracardial thrombus after prosthetic valve replacement.Methods The clinical data of 29 Cases from January 2005 to Apfil 2009 with intracardial thrombus after prosthetic valve replacement during a 1-year follow-up was retrospectively analyzed.There were 11 male and 18 female,aged from 12 to 70 years with a mean of 48 years.The risk factors of intracardial thrombus were examined by univariate and multivariate analysis.Results Univariate analysis found that bioprosthetic valve replacement,anticoagulation using aspirin,valve replacement at mitral position,atrial fibrillation,preoperative and postoperative internal diameter of left atrium,postoperative fibrinogen were predict factors of intracardial thrombus after prosthetic valve replacement(P<0.05).Logistic regression analysis showed valve replacement at mitml position(OR=9.815,P<0.05),atrial fibrillation(OR=5.267,P<0.05),preoperative internal diameter of left atrium(OR=4.529,P<0.05)were significant risk factors of intracardial thrombus after prosthetic valve replacement.Conclusions Valve replacement at mitral position,atrial fibrillation,and preoperative internal diameter of left atrium are the correlated risk factors of intracardial thrombus after prosthetic valve replacement.Anticoagulation after prosthetic valve(especially bioprosthetie valve)replacement should be standardized to prevent intraeardial thrombus formation.