70例心脏瓣膜病合并肺动脉高压行瓣膜手术疗效分析

目的观察心脏瓣膜病合并肺动脉高压行瓣膜手术的疗效,分析影响其手术疗效的因素。方法采用手术前后肺动脉收缩压（PASP）、左心室射血分数（LVEF）、术后并发症发生率及死亡率等作为疗效观察指标,评价不同年龄、性别、心功能分级及术前PASP等级患者的疗效。结果年龄〉60岁组患者的术后PASP变化值（25.86±4.27）mm Hg]及LVEF变化值（2.64±1.62）%]均低于年龄≤60岁组患者（28.37±3.53）mm Hg,（3.71±1.95）%],而术后并发症发生率（23.33%）及死亡率（13.33%）均高于年龄≤60岁组（12.50%,5.00%）,差异均有统计学意义（P〈0.05）。不同性别的各项疗效指标差异无统计学意义（P〉0.05）。随着心功能等级的升高,术后PASP值逐渐升高,LVEF值逐渐降低,并且并发症及死亡率也逐渐升高,差异均有统计学意义（P〈0.05）。术前PASP越高,术后PASP值及LVEF值变化越大（P〈0.05）,术后并发症发生率及死亡率越高（P〈0.05）。结论心脏瓣膜病合并肺动脉高压行瓣膜手术治疗的疗效与年龄有关,而与性别无关;心功能越差,术后的整体疗效越差;术前的PASP水平越高,疗效越差,应对其高危因素加以注意和控制。

Effect analysis of valvular surgery in 70 patients with heart valve disease combined with pulmonary hypertension

Objective To observe the surgical effect of heart valve disease combined with pulmonary hypertension,and analyze the influencing factors.Methods Preoperative and postoperative pulmonary artery systolic pressure(PASP),left ventricular ejection fraction(LVEF),the incidence of postoperative complications and mortality were taken as outcome measures,and the efficacy of different ages,gender,NYHA and preoperative PASP grades patients were evaluated.Results Change value of PASP (25.86±4.27) mm Hg] and LVEF (2.64±1.62)%] of>60 years old patients were lower than those of ≤ 60 years old patients (28.37±3.53) mm Hg,(3.71±1.95)%],while the incidence of complications(23.33%) and mortality(13.33%) of>60 years old patients were higher than those of ≤ 60 years old group(12.50%,5.00%),the differences were statistically significant(P<0.05).The treatment efficacy of different gender showed no statistically significant difference(P>0.05).With the increasing level of cardiac function,postoperative PASP value gradually increased,the LVEF value decreased,and the complications and mortality increased,the differences were statistically significant(P<0.05).With the higher degree of PASP preoperative,the greater postoperative PASP value and LVEF value changed(P<0.05),and the higher incidence of postoperative complications and mortality were(P<0.05).Conclusion The surgical effect of heart valve disease combined with pulmonary hypertension is related with age,but which is not related with gender;with the worse of heart function,the overall effect is worse too;with the higher of the preoperative PASP level,the effect is worse.Therefore,high risk factors should be attended and controlled.