马恩++王宗社+++舒端朝++王小军++赵龙

[摘要] 目的 探討重症心脏瓣膜病患者人工心脏瓣膜置换术后影响预后的危险因素。 方法 回顾性分析2014年1月～2016年12月于宝鸡市中心医院行人工心脏瓣膜置换术的200例重症瓣膜病患者的临床资料，分析影响患者术后预后的危险因素。 结果 200例患者术后均定期随访，平均随访时间为（18.2±6.7）个月，其中死亡28例，存活172例。单因素分析结果显示，人工瓣膜置换术后，存活者的年龄、体重指数、心功能分级、术前合并糖尿病和肾病、原发病、术前心脏手术史、手术方式、体外循环时间、动脉阻断时间等与死亡患者差异有统计学意义（P < 0.05）。Logistic多因素回归分析结果显示，年龄>60岁、体重指数<20 kg/m2或>35 kg/m2、心功能Ⅲ～Ⅳ级、术前合并糖尿病或糖尿病肾病、术前心脏手术史、体外循环时间≥160 min及动脉阻断时间≥120 min均是重症心脏瓣膜病患者人工瓣膜置换术后预后的影响因素（P < 0.05）。 结论 重症心脏瓣膜病患者人工瓣膜置换术后的预后情况受多种因素的影响，临床上应针对这些危险因素采取积极有效的应对措施，以改善患者的预后情况。

[关键词] 重症心脏瓣膜病；人工心脏瓣膜置换术；预后；危险因素

[中图分类号] R542.5 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0064-04

Analysis of the risk factors affecting prognosis of patients with advanced valvular hear disease afterartificial cardiac valve replacement

MA En WANG Zongshe SHU Duanchao WANG Xiaojun ZHAO Long

Department of Cardiac Surgery， Baoji Central Hospital， Shaanxi Province， Baoji 721008， China

[Abstract] Objective To explore the risk factors affecting the prognosis of patients with advanced valvular hear disease after artificial cardiac valve replacement. Methods From January 2014 to December 2016， in Baoji Central Hospital， the clinical data of 200 patients with advanced valvular hear disease were retrospectively analyzed， the risk factors affect the postoperative prognosis of patients were analyzed. Results Regular follow-up was carried among all the 200 pa？鄄tients， the average follow-up time was （18.2±6.7） months， and 28 cases dead and 172 cases survived. Single factor analysis results showed that age， body mass index， cardiac functional grading， combined diabetes and kidney disease preoperative， protopathy，history of preoperative cardiac surgery， operation method， cardiopulmonary bypass time， time of arterial blocking between survival and dead patients had statistically significant difference （P < 0.05）. Logistic multiple factors regression analysis results showed that age>60 years， body mass index<20 kg/m2 or >35 kg/m2， cardiac functional grade Ⅲ-Ⅳ， combined diabetes and kidney disease preoperative， protopathy，history of preoperative cardiac surgery， cardiopulmonary bypass time≥160 min， time of arterial blocking≥120 min were the influence factors ofprognosis of patients with severe valvular heart disease after artificial valve replacement. Conclusion Prognosis of patients with advanced valvular hear disease after artificial cardiac valve replacement can be influenced by many factors， so the positive and effective measures should be taken out to cope with the situation aimed at these factors，and to improve the prognosis of patients.endprint

[Key words] Advanced valvular hear disease； Artificial heart valve replacement； Prognosis； Risk factors

心脏瓣膜病是我国常见的一种心脏疾病，是指二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣的瓣膜因风湿热、黏液变性、退行性改变、缺血性坏死、感染或创伤以及先天性畸形等出现了病变，影响血液的正常流动，从而造成心脏功能异常，最终导致心力衰竭的单瓣膜或多瓣膜病变。心脏瓣膜病的原发病中以风湿热导致的瓣膜损害最为常见，而随着我国人口老龄化的加重，老年退行性瓣膜病及冠心病、心肌梗死等疾病引起的瓣膜病变越来越常见。……