心脏瓣膜病患者瓣膜置换术远期预后的危险因素

目的探讨行人工心脏瓣膜置换术患者远期预后的危险因素,为临床采取防治措施提供依据。方法选择2000年3月至2009年3月在北京安贞医院行人工心脏瓣膜置换术的心脏瓣膜病患者共1 246例,其中646例的随访数据为有效数据,有效数据通过Cox比例风险模型对潜在的危险因素进行单变量分析,初步筛查出具有统计学意义的危险因素,然后再通过多变量回归进行独立危险因素分析。结果高龄(年龄>65岁)、心功能分级Ⅳ级、术前并发糖尿病、术前并发肾损伤、术后未严格遵照医嘱、肺部感染、主动脉阻断时间(61～90 min)、术后射血分数≤40%、二次换瓣手术及抗凝治疗不当均为影响人工心脏瓣膜置换术患者远期预后的高危因素。结论影响心脏瓣膜病患者瓣膜置换术远期预后的危险因素具有多样化的特点,不同患者手术后应结合其相关危险因素和自身的疾病特点,进行综合防治。

Risk factors for long-term prognosis of heart valve replacement in patients with valvular heart disease

Objective To investigate the risk factors for the long-term prognosis of artificial heart valve replacement, and provide evidence for clinical preventive measures. Methods A total of 1 246 patients with valvular heart disease pre- formed with artificial heart valve replacement were selected in Beijing Anzhen Hospital from March 2000 to March 2009. A- mong all the patients, the follow up data in 646 cases were valid data. The univariate analysis of the valid data was analyzed through the Cox proportional hazard model to preliminary screening out the statistically significant risk factors,and then the in- dependent risk factors were analyzed by multivariate regression analysis. Results Advanced age （ 〉 65 years） , heart function class 1V ,preoperative diabetes, preoperative renal dysfunction, not strictly follow doctor＇s orders, pulmonary infection, aortic clamping time in 61 -90 minutes,postoperative ejection fraction ≤40% , the second valve replacement surgery and improper anticoagulation were the high risk factors for long-term prognosis in patients performed with artificial heart valve replacement. Conclusions The characteristic of the risk factors for long-term prognosis of heart valve replacement was diversified. Different patients should received comprehensively prevention and treatment after surgery combined with the existing related risk factors and their disease characteristics.