720例機(jī)械瓣膜置換術(shù)圍手術(shù)期并發(fā)癥相關(guān)危險(xiǎn)因素分析
發(fā)布時(shí)間：2018-07-14 17:25
【摘要】：[目的]心瓣膜病(valvular heart disease,VHD)仍然是臨床和公共健康的負(fù)擔(dān)。對于發(fā)展中國家來說,風(fēng)濕熱仍然是導(dǎo)致心瓣膜病主要發(fā)病原因。在我國,成人風(fēng)濕性心瓣膜病的發(fā)病率為2.34‰～2.72‰。心瓣膜病的治療分為內(nèi)科治療和外科治療,其中外科治療方法是瓣膜疾病唯一有效能夠明顯改善患者癥狀及預(yù)后的方法。在云南地區(qū),外科治療心瓣膜病的方法主要是人工機(jī)械瓣膜置換術(shù)。雖然經(jīng)過了接近半個(gè)世紀(jì)的發(fā)展,心臟手術(shù)在體外循環(huán)(Cardiopulmpnary Bypass CPB)的支持下已經(jīng)非常成熟,但毋庸置疑的是它仍然是一個(gè)非常復(fù)雜且特殊的手術(shù),術(shù)前患者生理狀態(tài)、手術(shù)時(shí)長、圍手術(shù)期的各種侵入性操作、體外循環(huán)、機(jī)械異物的植入等共同構(gòu)成了圍術(shù)期的高危因素,忽略它們將帶來致命的后果。本次研究統(tǒng)計(jì)在我科行單純?nèi)斯C(jī)械瓣膜置換術(shù)的患者的術(shù)前及術(shù)中資料及在圍術(shù)期發(fā)生的各類并發(fā)癥,分析導(dǎo)致并發(fā)癥的相關(guān)危險(xiǎn)因素,采取相應(yīng)預(yù)防措施,為減少及預(yù)防云南地區(qū)心臟瓣膜置換術(shù)圍手術(shù)期的并發(fā)癥提供一定的參考依據(jù)。[方法]根據(jù)國內(nèi)外文獻(xiàn)及相關(guān)風(fēng)險(xiǎn)模型的納入標(biāo)準(zhǔn),篩選出2011年1月1日至2013年3月1日期間在延安醫(yī)院心臟大血管外科接受人工機(jī)械瓣膜換瓣手術(shù)的患者,共720例,納入的潛在危險(xiǎn)因素有如下:年齡、性別、病程、房顫、心功能分級、高血壓史、糖尿病史、肝腎功能、心臟射血分?jǐn)?shù)(EF值)、左室舒張末容積(LVEDV)、左房舒張末期容積(LAEDV)、手術(shù)方式、疾病種類、轉(zhuǎn)流時(shí)間、阻斷時(shí)間。統(tǒng)計(jì)的圍術(shù)期并發(fā)癥有:低心排綜合癥、室顫(Ventricular FibrillationVF)、心律紊亂、腎功能衰竭、肝功能衰竭、MODS、腦梗、低氧血癥、心跳驟停、循環(huán)不穩(wěn)定、心包填塞、心包積液、胸腔積液、肺部炎性滲出。統(tǒng)計(jì)學(xué)方法采用方差分析,卡方檢驗(yàn)先篩查出相關(guān)聯(lián)的潛在危險(xiǎn)因素,再用Logistic單因素和多因素?cái)M合回歸模型,利用SPSS 22統(tǒng)計(jì)分析軟件嘗試找出潛在危險(xiǎn)因素和相關(guān)并發(fā)癥之間的聯(lián)系。[結(jié)果]720例患者中總的并發(fā)癥人數(shù)為220人;其中低心排綜合征為31例(10.8%)、室顫2例(0.7%)、心律紊亂47例(16.7%)、急性腎衰竭7例(2.4%)、肝衰2例(0.7%)、MODS 5例(1.7%)、腦梗6例(2.1%)、低氧血癥4例(1.4%)、心跳驟停2例(0.7%)、循環(huán)不穩(wěn)定15例(5.2%)、心包填塞2例(0.7%)、心包積液75例(26.1%)、胸腔積液14例(4.9%)、瓣周漏1例(0.3%)、肺部炎性滲出74例(25.8%);死亡6人。Logistic單因素分析結(jié)果為年齡、性別、糖尿病史、術(shù)前房顫、風(fēng)濕性心臟瓣膜病、退行性二尖瓣病變、手術(shù)方式分別是圍術(shù)期心跳驟停、急性腎衰竭、循環(huán)不穩(wěn)定、心律紊亂、低氧血癥、室顫的獨(dú)立危險(xiǎn)因素(P0.05);病程時(shí)間長是圍術(shù)期低氧血癥、腎衰、胸腔積液的獨(dú)立危險(xiǎn)因素(P0.05);感染性心內(nèi)膜炎是圍術(shù)期出現(xiàn)MODS、肝功能障礙、腎衰竭的獨(dú)立危險(xiǎn)因素(P0.05);LVEDV是圍術(shù)期出現(xiàn)低心排綜合征、MODS、心律紊亂的獨(dú)立危險(xiǎn)因素(P0.05) ; LAEDV是出現(xiàn)腎衰、循環(huán)不穩(wěn)、心包積液(10mm)的獨(dú)立危險(xiǎn)因素(P0.05);轉(zhuǎn)流時(shí)間是圍術(shù)期出現(xiàn)低心排綜合征、腎衰、循環(huán)不穩(wěn)定、心包填塞、心包積液的獨(dú)立危險(xiǎn)因素(P0.05);阻斷時(shí)間是出現(xiàn)低心排綜合征、循環(huán)不穩(wěn)定、心包積液、胸腔積液、心包填塞的獨(dú)立危險(xiǎn)因素(P0.05) ; Logistic多因素回歸模型分析顯示:EF值、LVEDV、轉(zhuǎn)流時(shí)間、阻斷時(shí)間共同為圍術(shù)期出現(xiàn)低心排綜合征的危險(xiǎn)因素(P0.05);性別、病程、肌酐值、LAEDV、轉(zhuǎn)流時(shí)間、阻斷時(shí)間是圍術(shù)期發(fā)生急性腎功衰的危險(xiǎn)因素(P0.05);術(shù)前肌酐值、LVEDV、主動(dòng)脈瓣置換術(shù)是圍術(shù)期發(fā)生MODS的危險(xiǎn)因素(P0.05);轉(zhuǎn)流時(shí)間和阻斷時(shí)間是圍術(shù)期發(fā)生腦梗的的危險(xiǎn)因素(P0.05);術(shù)前糖尿病史、LAEDV、轉(zhuǎn)流時(shí)間、阻斷時(shí)間是圍術(shù)期發(fā)生循環(huán)不穩(wěn)定的的危險(xiǎn)因素(P0.05)。[結(jié)論]本次研究發(fā)現(xiàn)心臟瓣膜手術(shù)的治療效果和患者病史、各重要器官功能狀態(tài)、心臟病理改變、手術(shù)的方式、體外循環(huán)時(shí)間、圍術(shù)期處理等多種因素密切相關(guān),圍術(shù)期各種并發(fā)癥的出現(xiàn)是一個(gè)復(fù)雜的生理病理過程。手術(shù)前謹(jǐn)慎選擇手術(shù)患者,制定安全有效的手術(shù)措施、術(shù)中、術(shù)后予相應(yīng)有效地治療措施一定能有效降低心臟換瓣術(shù)后圍術(shù)期患者的并發(fā)癥發(fā)生率。
[Abstract]:[Objective] valvular heart disease (VHD) is still a burden of clinical and public health. For developing countries, rheumatic fever is still the main cause of heart valvular disease. In China, the incidence of rheumatic valvular disease in adults is 2.34 to 2.72 per thousand. The treatment of heart valvular disease is divided into internal medicine treatment and surgical treatment. Surgical treatment is the only effective way to improve the symptoms and prognosis of patients with valvular disease. In Yunnan, surgical treatment of valvular heart valve disease is mainly by prosthetic valve replacement. Although after nearly half a century of development, cardiac surgery has been supported by Cardiopulmpnary Bypass CPB in vitro. It is very mature, but it is unquestionable that it is still a very complex and special operation. The physiological state of the patients, the length of the operation, the various invasive operations in the perioperative period, the extracorporeal circulation, the implantation of the mechanical foreign body together constitute the high risk factors of the perioperative period, ignoring the fatal consequences. This study statistics is in our department. The preoperative and intraoperative data of patients with simple mechanical valve replacement and the various complications during the perioperative period, analyze the related risk factors leading to the complications and take corresponding preventive measures to provide some reference for reducing and preventing the perioperative complication of heart valve replacement in Yunnan. The inclusion criteria of internal and external literature and related risk models were used to screen 720 patients undergoing cardiac valve replacement surgery at Yanan hospital from January 1, 2011 to March 1, 2013. The potential risk factors included age, sex, disease course, atrial fibrillation, cardiac function classification, hypertension history, diabetes history, liver Renal function, cardiac ejection fraction (EF), left ventricular end diastolic volume (LVEDV), left atrium end diastolic volume (LAEDV), surgical methods, disease types, bypass time, blocking time. The perioperative complications were low cardiac syndrome, ventricular fibrillation (Ventricular FibrillationVF), arrhythmia, renal failure, liver failure, MODS, cerebral infarction, hypoxia. Anemia, cardiac arrest, circulatory instability, pericardial filling, pericardial effusion, pleural effusion, pulmonary inflammatory exudation. Statistical methods were analyzed by variance analysis. The associated potential risk factors were screened by chi square test, and Logistic single factor and multiple factor fitting regression model were used, and SPSS 22 statistical analysis software was used to try to find potential risk factors. [results] the total number of complications in]720 patients was 220, including 31 cases of low cardiac syndrome (10.8%), 2 cases of ventricular fibrillation (0.7%), 47 cases of arrhythmia (16.7%), 7 cases of acute renal failure (2.4%), 2 cases of liver failure (0.7%), 5 cases (1.7%), cerebral infarction, hypoxemia, cardiac arrest, and circulation. 15 cases were unstable (5.2%), pericardial filling in 2 cases (0.7%), pericardial effusion in 75 cases (26.1%), pleural effusion in 14 cases (4.9%), pericardial leakage in 1 cases (0.3%), pulmonary inflammatory exudation in 74 cases (25.8%); death 6.Logistic single factor analysis results were age, sex, diabetes history, anterior chamber fibrillation, rheumatic valvular heart valvular disease, and degenerative mitral valve disease. The surgical methods were respectively operation methods, respectively. Perioperative cardiac arrest, acute renal failure, circulatory instability, arrhythmia, hypoxemia, independent risk factors for ventricular fibrillation (P0.05); long course time is an independent risk factor for perioperative hypoxemia, renal failure, and pleural effusion (P0.05); infectious endocarditis is an independent risk factor for the emergence of MODS, liver dysfunction and renal failure during the perioperative period (P0.05 LVEDV is an independent risk factor (P0.05) with low cardiac output syndrome, MODS and arrhythmia in the perioperative period; LAEDV is an independent risk factor (P0.05) of renal failure, circulatory instability and pericardial effusion (10mm); the time of bypass is an independent risk factor (P0.05) in the perioperative period of low cardiac syndrome, renal failure, circulatory instability, pericardial filling, and pericardial effusion. Blocking time was an independent risk factor for the emergence of low cardiac output syndrome, circulatory instability, pericardial effusion, pleural effusion, and pericardial tamponade (P0.05); Logistic multiple regression model analysis showed that EF, LVEDV, bypass time and blocking time were the risk factors for low cardiac output syndrome (P0.05) in peri operative period; sex, course of disease, creatinine, LAEDV, Time and interruption time were risk factors for acute renal failure during perioperative period (P0.05); preoperative creatinine value, LVEDV, aortic valve replacement were risk factors for MODS in the perioperative period (P0.05); time and blocking time were the risk factors of cerebral infarction (P0.05) in perioperative period; preoperative diabetes history, LAEDV, bypass time, blocking time The risk factors of circulatory instability during the perioperative period (P0.05). [Conclusion] this study found that the therapeutic effect of cardiac valve surgery, the history of the patients, the function state of the important organs, the pathological changes of the heart, the mode of operation, the time of extracorporeal circulation, the treatment of perioperative period are closely related, and the occurrence of various complications in the perioperative period is one Complex physiological and pathological processes. Careful selection of surgical patients before operation, safe and effective surgical measures, and appropriate effective treatment in the operation and after operation are sure to effectively reduce the incidence of complications in the perioperative patients after heart valve replacement.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.2
本文編號：2122373
[Abstract]:[Objective] valvular heart disease (VHD) is still a burden of clinical and public health. For developing countries, rheumatic fever is still the main cause of heart valvular disease. In China, the incidence of rheumatic valvular disease in adults is 2.34 to 2.72 per thousand. The treatment of heart valvular disease is divided into internal medicine treatment and surgical treatment. Surgical treatment is the only effective way to improve the symptoms and prognosis of patients with valvular disease. In Yunnan, surgical treatment of valvular heart valve disease is mainly by prosthetic valve replacement. Although after nearly half a century of development, cardiac surgery has been supported by Cardiopulmpnary Bypass CPB in vitro. It is very mature, but it is unquestionable that it is still a very complex and special operation. The physiological state of the patients, the length of the operation, the various invasive operations in the perioperative period, the extracorporeal circulation, the implantation of the mechanical foreign body together constitute the high risk factors of the perioperative period, ignoring the fatal consequences. This study statistics is in our department. The preoperative and intraoperative data of patients with simple mechanical valve replacement and the various complications during the perioperative period, analyze the related risk factors leading to the complications and take corresponding preventive measures to provide some reference for reducing and preventing the perioperative complication of heart valve replacement in Yunnan. The inclusion criteria of internal and external literature and related risk models were used to screen 720 patients undergoing cardiac valve replacement surgery at Yanan hospital from January 1, 2011 to March 1, 2013. The potential risk factors included age, sex, disease course, atrial fibrillation, cardiac function classification, hypertension history, diabetes history, liver Renal function, cardiac ejection fraction (EF), left ventricular end diastolic volume (LVEDV), left atrium end diastolic volume (LAEDV), surgical methods, disease types, bypass time, blocking time. The perioperative complications were low cardiac syndrome, ventricular fibrillation (Ventricular FibrillationVF), arrhythmia, renal failure, liver failure, MODS, cerebral infarction, hypoxia. Anemia, cardiac arrest, circulatory instability, pericardial filling, pericardial effusion, pleural effusion, pulmonary inflammatory exudation. Statistical methods were analyzed by variance analysis. The associated potential risk factors were screened by chi square test, and Logistic single factor and multiple factor fitting regression model were used, and SPSS 22 statistical analysis software was used to try to find potential risk factors. [results] the total number of complications in]720 patients was 220, including 31 cases of low cardiac syndrome (10.8%), 2 cases of ventricular fibrillation (0.7%), 47 cases of arrhythmia (16.7%), 7 cases of acute renal failure (2.4%), 2 cases of liver failure (0.7%), 5 cases (1.7%), cerebral infarction, hypoxemia, cardiac arrest, and circulation. 15 cases were unstable (5.2%), pericardial filling in 2 cases (0.7%), pericardial effusion in 75 cases (26.1%), pleural effusion in 14 cases (4.9%), pericardial leakage in 1 cases (0.3%), pulmonary inflammatory exudation in 74 cases (25.8%); death 6.Logistic single factor analysis results were age, sex, diabetes history, anterior chamber fibrillation, rheumatic valvular heart valvular disease, and degenerative mitral valve disease. The surgical methods were respectively operation methods, respectively. Perioperative cardiac arrest, acute renal failure, circulatory instability, arrhythmia, hypoxemia, independent risk factors for ventricular fibrillation (P0.05); long course time is an independent risk factor for perioperative hypoxemia, renal failure, and pleural effusion (P0.05); infectious endocarditis is an independent risk factor for the emergence of MODS, liver dysfunction and renal failure during the perioperative period (P0.05 LVEDV is an independent risk factor (P0.05) with low cardiac output syndrome, MODS and arrhythmia in the perioperative period; LAEDV is an independent risk factor (P0.05) of renal failure, circulatory instability and pericardial effusion (10mm); the time of bypass is an independent risk factor (P0.05) in the perioperative period of low cardiac syndrome, renal failure, circulatory instability, pericardial filling, and pericardial effusion. Blocking time was an independent risk factor for the emergence of low cardiac output syndrome, circulatory instability, pericardial effusion, pleural effusion, and pericardial tamponade (P0.05); Logistic multiple regression model analysis showed that EF, LVEDV, bypass time and blocking time were the risk factors for low cardiac output syndrome (P0.05) in peri operative period; sex, course of disease, creatinine, LAEDV, Time and interruption time were risk factors for acute renal failure during perioperative period (P0.05); preoperative creatinine value, LVEDV, aortic valve replacement were risk factors for MODS in the perioperative period (P0.05); time and blocking time were the risk factors of cerebral infarction (P0.05) in perioperative period; preoperative diabetes history, LAEDV, bypass time, blocking time The risk factors of circulatory instability during the perioperative period (P0.05). [Conclusion] this study found that the therapeutic effect of cardiac valve surgery, the history of the patients, the function state of the important organs, the pathological changes of the heart, the mode of operation, the time of extracorporeal circulation, the treatment of perioperative period are closely related, and the occurrence of various complications in the perioperative period is one Complex physiological and pathological processes. Careful selection of surgical patients before operation, safe and effective surgical measures, and appropriate effective treatment in the operation and after operation are sure to effectively reduce the incidence of complications in the perioperative patients after heart valve replacement.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R654.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前7條
1 王寅;董念國;;心臟瓣膜外科:回顧過去 展望未來[J];心血管外科雜志(電子版);2015年01期
2 吐爾遜阿依·買買提;余瑾;鄭宏;;新疆地區(qū)心臟瓣膜置換術(shù)后死亡危險(xiǎn)因素分析[J];中國胸心血管外科臨床雜志;2015年02期
3 譚宏衛(wèi);曾捷;;Logistic回歸模型的影響分析[J];數(shù)理統(tǒng)計(jì)與管理;2013年03期
4 陸升;;體外循環(huán)心肌損傷機(jī)制及其保護(hù)的研究進(jìn)展[J];右江醫(yī)學(xué);2011年05期
5 楊威;董嘯;;體外循環(huán)所致炎性肺損傷機(jī)制及保護(hù)進(jìn)展[J];醫(yī)學(xué)與哲學(xué)(臨床決策論壇版);2011年04期
6 湛守青;祁國榮;路霖;王黎明;;西寧地區(qū)心臟瓣膜置換術(shù)后并發(fā)癥分析及防治[J];高原醫(yī)學(xué)雜志;2007年02期
7 許傳青,曹國駿,徐小虎,陳耀文,于曉軍;人工心臟瓣膜置換術(shù)后近期死亡因素的Logistic回歸模型與分析[J];生物數(shù)學(xué)學(xué)報(bào);2005年02期
相關(guān)博士學(xué)位論文 前1條
1 杜娟;心臟術(shù)后急性腎損傷進(jìn)展預(yù)測及診斷標(biāo)準(zhǔn)比較的研究[D];北京協(xié)和醫(yī)學(xué)院;2013年
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