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术后早期死亡原因和相关因素。方法对385例行心脏瓣膜置换手术患者的临床资料和术后早期死亡原因及相关因素进行统计分析。结果手术后早期死亡18例，病死率4．68％。主要死亡原因依次为：低心排血量综合征8例，多脏器功能衰竭7例，严重的室性心律失常2例，左心室破裂1例。单变量分析提示，年龄、手术前心功能分级、阻断时间、体外循环时间及心胸比与心脏瓣膜置换术后死亡的发生具有明显相关性（P〈0．01）。多变量Logistic回归分析提示，年龄、心功能与心胸比是心脏瓣膜置换术后早期死亡发生的独立危险因素（P〈0．05）。结论低心排血量综合征、多脏器功能衰竭、严重室性心律失常是瓣膜置换术后早期死亡主要原因。手术前积极改善心功能，提高手术技巧，尽量缩短主动脉阻断时间和体外循环时间，加强手术中心肌保护和手术后的监护及综合治疗措施，可望提高瓣膜置换手术的成功率。

Analysis of causes and related factors of death during the early period after cardiac valve replacement

Objective To identify causes and related factors of death during the early period after cardiac valve replacement. Methods Clinical data of 385 cases of valve replacement were collected and analyzed retrospectively. Results 18 cases died during the early period after cardiac valve replacement. The early postoperative mortality rate was 4.68% .The main causes of the early postoperative death in order were:low cardiac output syndrome(8 cases),multiple system organ failure (7 cases), severe ventricular arrhythmias(2 cases) and rupture of left ventricle(1 case). Univariate analysis revealed that age ,NYHA function class, cardiothoracic ratio(CTR), aortic cross-clamping time and cardiopulmonary bypass time were closely linked with mortality(P<0.01). Multivariate logistic regression analysis revealed that age ,NYHA functional class and CTR had an independent influence on death during the early period after cardiac valve replacement. Conclusion Low cardiac output syndrome,multiple system orgen failure and severe ventricular arrhythmias are the main causes of early postoperative death following valve replacement.