本文關(guān)鍵詞：心臟瓣膜置換術(shù)后慢性左室收縮功能不全相關(guān)因素分析　出處：《福建醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：目的：隨著體外循環(huán)灌注、心肌保護(hù)、麻醉技術(shù)、人造瓣膜的研究、手術(shù)水平的提高等方面取得了令人矚目的進(jìn)步，但仍有部分患者換瓣術(shù)后心功能不僅未得到明顯的改善反而出現(xiàn)了降低。為進(jìn)一步提高瓣膜置換術(shù)后患者的生存質(zhì)量，以進(jìn)一步指導(dǎo)臨床工作，本文就針對(duì)心臟瓣膜置換術(shù)后慢性左室收縮功能不全的發(fā)生的相關(guān)因素進(jìn)行探討。 方法：從福建醫(yī)科大學(xué)附屬協(xié)和醫(yī)院病案室收集2008年1月1日至2012年12月31日期間選出心功能正常組及心功能不全組作為研究對(duì)象。從已確定的研究對(duì)象的臨床資料中選取可能與慢性左心收縮功能不全的臨床變量，確定各入選臨床變量的取值方式，，再將全部入選臨床變量分為分類(lèi)變量和連續(xù)變量?jī)纱箢?lèi)，最后采用Logistic回歸分析。 結(jié)果：（1）從總體水平出發(fā)研究，心臟瓣膜置換術(shù)后慢性左室收縮功能不全的相關(guān)因素有：術(shù)前左室收縮末期內(nèi)徑（P＜0.001）、二尖瓣保留情況（P=0.043）、術(shù)前是否合并房顫（P=0.007）、術(shù)前是否出現(xiàn)暈厥（P=0.022）、術(shù)后是否使用腎上腺素（P=0.032）、術(shù)前左室射血分?jǐn)?shù)（P=0.003）。（2）從瓣膜置換術(shù)的種類(lèi)出發(fā)研究，單純二尖瓣置換術(shù)的獨(dú)立相關(guān)因素有：性別（P=0.002），同期是否行左房折疊（P=0.013）、二尖瓣類(lèi)型（國(guó)產(chǎn)還是進(jìn)口）（P=0.003）。單純主動(dòng)脈瓣置換術(shù)：術(shù)前左室射血分?jǐn)?shù)（P＜0.001）、術(shù)后是否使用腎上腺素（P=0.025）、術(shù)后是否使用多巴酚丁胺（P=0.029）、ICU住院時(shí)間（P=0.049）。同期行二尖瓣及主動(dòng)脈瓣置換術(shù)：術(shù)前左室射血分?jǐn)?shù)（P＜0.001）。 結(jié)論：心臟瓣膜置換術(shù)后左室收縮功能不全的相關(guān)因素有：術(shù)前左室收縮末期內(nèi)徑，術(shù)前左室射血分?jǐn)?shù)、二尖瓣保留情況、術(shù)前是否合并房顫、術(shù)前是否出現(xiàn)暈厥、性別、同期有無(wú)行左房折疊、二尖瓣類(lèi)型（國(guó)產(chǎn)還是進(jìn)口）、術(shù)后是否使用腎上腺素、術(shù)后是否使用多巴酚丁胺、ICU住院時(shí)間。
[Abstract]:Objective: with the development of cardiopulmonary bypass (CPB) cardiopulmonary bypass (CPB), myocardial protection, anesthetic technique, artificial valve research, and the improvement of surgical level, etc, remarkable progress has been made. But there are still some patients after valve replacement heart function has not been significantly improved but decreased. In order to further improve the quality of life of patients after valve replacement in order to further guide the clinical work. This paper discusses the related factors of chronic left ventricular systolic dysfunction after cardiac valve replacement. Methods:. From January 1st 2008 to December 31st 2012, the patients with normal cardiac function and heart failure were selected from the medical records department of Union Hospital of Fujian Medical University. The clinical data of the subjects were selected from the clinical variables that may be associated with chronic left ventricular systolic dysfunction. The clinical variables were divided into two categories: classified variables and continuous variables. Finally, Logistic regression analysis was used. Results the relative factors of chronic left ventricular systolic dysfunction after valvular replacement were as follows: preoperative left ventricular end-systolic diameter (P < 0.001). The mitral valve retention was 0.043%, whether atrial fibrillation was associated with P0. 007, and whether there was syncope before operation was 0. 022 (P < 0. 022). Whether or not to use adrenocephalin 0.032, left ventricular ejection fraction (LVEF) before operation was studied from the type of valve replacement. The independent related factors of simple mitral valve replacement were as follows: sex was 0.002, and left atrial folding was performed at the same time (P = 0.013). Mitral valve type (domestic or imported). Simple aortic valve replacement: left ventricular ejection fraction (LVEF) before operation (P < 0.001). Whether to use adrenocephalin 0.025 or dobutamine 0.029 after operation. ICU was treated with mitral valve replacement and aortic valve replacement at the same time (P < 0.001). Conclusion: the related factors of left ventricular systolic dysfunction after cardiac valve replacement are left ventricular end-systolic diameter preoperative left ventricular ejection fraction mitral valve retention and atrial fibrillation before operation. Whether syncope occurred before operation, sex, left atrial folding, mitral valve type (domestic or imported), adrenaline after operation, and hospitalization time of ICU with dobutamine after operation.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R654.2

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