二尖瓣位人工瓣膜—患者不匹配現(xiàn)象的單中心回顧性研究
發(fā)布時(shí)間：2019-01-15 07:09
【摘要】：目的本研究擬探究我中心二尖瓣置換術(shù)后患者人工瓣膜-患者不匹配(PPM)現(xiàn)象的發(fā)生概率,分析該現(xiàn)象發(fā)生的可能危險(xiǎn)因素,并探究其對(duì)患者短期預(yù)后的影響。從而為術(shù)中預(yù)防人工瓣膜-患者不匹配現(xiàn)象的發(fā)生提供臨床依據(jù),為臨床處理、應(yīng)對(duì)該現(xiàn)象提供參考。方法本研究采用回顧性研究的方法,納入2013年-2015年于我中心行單純或合并二尖瓣置換術(shù)的所有患者資料,經(jīng)篩選和排除后,共納入1067例患者資料進(jìn)行分析。利用患者使用人工瓣膜的有效開(kāi)口面積及患者體表面積計(jì)算患者的有效開(kāi)口面積指數(shù),并根據(jù)該指數(shù)將患者分為人工瓣膜不匹配組(PPM組,共189例)及非不匹配組(非PPM組,共878例)。比較兩組患者的一般信息、臨床表現(xiàn)、既往病史、術(shù)前檢查結(jié)果、術(shù)中信息及術(shù)后并發(fā)癥發(fā)生情況等資料。通過(guò)邏輯回歸,分析人工瓣膜不匹配現(xiàn)象發(fā)生的術(shù)前預(yù)測(cè)因子,并分析不匹配現(xiàn)象對(duì)于患者術(shù)后短期死亡率的影響。結(jié)果共計(jì)1067例患者資料納入研究,其中人工瓣膜不匹配現(xiàn)象的發(fā)生率為17.7%,其中重度PPM的發(fā)生率為1.12%。在術(shù)前臨床資料方面,PPM組在平均年齡(63 vs54,P0.001)、男性比例(35.5%vs47.1%,P0.001)、體表面積(1.64±0.17m~2 vs 1.55 ± 0.16m~2,P0.001)、BMI(23.34 ± 2.86kg/m~2 vs 22.07 ± 3.79 kg/m~2,P0.001)、吸煙史比例(16.9%vs 10.4%,P=0.016)、高血壓(24.9%vs 16.5%,P=0.009)及冠心病(4.8%vs1.5%,P=0.009)發(fā)生率方面高于非PPM組。而在置換生物瓣患者中,PPM組術(shù)前二尖瓣狹窄比例顯著高于非PPM組(58.3%vs 41.7%,P=0.019)。兩組患者在其他既往病史、房顫、術(shù)前心功能、左室射血分?jǐn)?shù)、左室舒張末期內(nèi)徑、左房?jī)?nèi)徑、急診手術(shù)比例等方面無(wú)顯著差異。在手術(shù)資料方面,PPM組生物瓣置換(50.8%vs 11.7%,,P0.001)比例顯著高于非PPM組,搭橋(5.8%vs1.9%,P=0.005)及房顫(15.9%vs 8.7%,P=0.005)合并手術(shù)比例相對(duì)較高。二元邏輯回歸分析表明高齡(P=0.011)、大體表面積(P0.001)、生物瓣(P0.001)和小左室舒張末期內(nèi)徑(P0.001)是PPM發(fā)生的術(shù)前危險(xiǎn)因素。兩組患者在術(shù)后并發(fā)癥情況方面無(wú)明顯差異,術(shù)后短期共9名患者死亡,死亡率為0.84%,邏輯回歸分析表明PPM并不是術(shù)后短期死亡的影響因素(P=0.654)。隨訪結(jié)果表明,PPM組及非PPM組隨訪心功能Ⅲ-Ⅳ級(jí)均為9%左右,在中短期心功能方面無(wú)明顯差異(9.6%vs9.0%,P=0.902)。結(jié)論本研究表明,高齡、生物瓣置換、體表面積及左室舒張末期內(nèi)徑同二尖瓣位PPM發(fā)生有顯著關(guān)聯(lián),但二尖瓣位PPM對(duì)二尖瓣置換術(shù)后中短期預(yù)后無(wú)明顯影響。我國(guó)華東地區(qū)患者,二尖瓣狹窄比例較高,因此PPM標(biāo)準(zhǔn)是否適用于該地區(qū)患者仍有待進(jìn)一步探究。
[Abstract]:Objective to investigate the probability of (PPM) mismatch in patients with mitral valve replacement, to analyze the possible risk factors of this phenomenon and to explore its influence on the short-term prognosis of the patients with mitral valve replacement. It can provide clinical basis for prevention of prosthetic valvular mismatch during operation and provide reference for clinical treatment. Methods the data of all patients undergoing mitral valve replacement or simple mitral valve replacement from 2013 to 2015 were analyzed by retrospective study. After screening and exclusion, 1067 patients were analyzed. The effective opening area index of patients was calculated by using the effective opening area of prosthetic valve and the surface area of patients. According to the index, patients were divided into two groups: PPM group (n = 189) and non-matched group (non-PPM group). There were 878 cases. The general information, clinical manifestation, past medical history, preoperative examination results, intraoperative information and postoperative complications were compared between the two groups. By means of logical regression, the factors that predict the occurrence of prosthetic valve mismatch were analyzed, and the influence of mismatch on short-term mortality after operation was analyzed. Results A total of 1067 patients were included in the study. The incidence of prosthetic valve mismatch was 17. 7 and the incidence of severe PPM was 1. 12. In the preoperative clinical data, the average age (63 vs54,P0.001), male ratio (35.5vs47.1%), body surface area (1.64 鹵0.17m~2 vs 1.55 鹵0.16 mm2 P0.001) in PPM group were significantly higher than those in control group (P 0.001). BMI (23.34 鹵2.86kg/m~2 vs 22.07 鹵3.79 kg/m~2,P0.001), proportion of smoking history (16.9%vs 10.4), 24.9%vs (16.5 kg/m~2,P0.001), The incidence of coronary heart disease (P0. 009) and coronary heart disease (4. 8 vs 1. 5% P0. 009) was higher than that in non-PPM group. The mitral stenosis rate in PPM group was significantly higher than that in non PPM group (58.3%vs 41.7). There was no significant difference between the two groups in other medical history, atrial fibrillation, preoperative cardiac function, left ventricular ejection fraction, left ventricular end-diastolic diameter, left atrial diameter and the proportion of emergency surgery. In terms of surgical data, the ratio of 50.8%vs 11.7T / P0.001 in PPM group was significantly higher than that in non-PPM group, and the ratio of bypass graft (5.8 vs 1.9) and atrial fibrillation (15.9%vs 8.7) was significantly higher than that in non-PPM group. P0. 005) the ratio of combined operation was relatively high. Binary logistic regression analysis showed that old age (P0. 011), large body surface area (P0. 001), biological flap (P0. 001) and left ventricular end diastolic diameter (P0. 001) were the risk factors of PPM. There was no significant difference in postoperative complications between the two groups. Nine patients died and the mortality rate was 0.84.The logistic regression analysis showed that PPM was not the influencing factor of short-term postoperative mortality (P0. 654). The follow-up results showed that the heart function of PPM group and non-PPM group were about 9%, and there was no significant difference in heart function between middle and short term (9.6vs9.00.902). Conclusion there is a significant correlation between PPM in mitral valve position and advanced age, biological valve replacement, surface area and left ventricular end-diastolic diameter, but mitral valve PPM has no significant effect on the short and medium term prognosis of mitral valve replacement. The mitral stenosis ratio is high in East China, so whether the PPM standard can be applied to the patients in this area remains to be further explored.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R654.2
本文編號(hào)：2408962
[Abstract]:Objective to investigate the probability of (PPM) mismatch in patients with mitral valve replacement, to analyze the possible risk factors of this phenomenon and to explore its influence on the short-term prognosis of the patients with mitral valve replacement. It can provide clinical basis for prevention of prosthetic valvular mismatch during operation and provide reference for clinical treatment. Methods the data of all patients undergoing mitral valve replacement or simple mitral valve replacement from 2013 to 2015 were analyzed by retrospective study. After screening and exclusion, 1067 patients were analyzed. The effective opening area index of patients was calculated by using the effective opening area of prosthetic valve and the surface area of patients. According to the index, patients were divided into two groups: PPM group (n = 189) and non-matched group (non-PPM group). There were 878 cases. The general information, clinical manifestation, past medical history, preoperative examination results, intraoperative information and postoperative complications were compared between the two groups. By means of logical regression, the factors that predict the occurrence of prosthetic valve mismatch were analyzed, and the influence of mismatch on short-term mortality after operation was analyzed. Results A total of 1067 patients were included in the study. The incidence of prosthetic valve mismatch was 17. 7 and the incidence of severe PPM was 1. 12. In the preoperative clinical data, the average age (63 vs54,P0.001), male ratio (35.5vs47.1%), body surface area (1.64 鹵0.17m~2 vs 1.55 鹵0.16 mm2 P0.001) in PPM group were significantly higher than those in control group (P 0.001). BMI (23.34 鹵2.86kg/m~2 vs 22.07 鹵3.79 kg/m~2,P0.001), proportion of smoking history (16.9%vs 10.4), 24.9%vs (16.5 kg/m~2,P0.001), The incidence of coronary heart disease (P0. 009) and coronary heart disease (4. 8 vs 1. 5% P0. 009) was higher than that in non-PPM group. The mitral stenosis rate in PPM group was significantly higher than that in non PPM group (58.3%vs 41.7). There was no significant difference between the two groups in other medical history, atrial fibrillation, preoperative cardiac function, left ventricular ejection fraction, left ventricular end-diastolic diameter, left atrial diameter and the proportion of emergency surgery. In terms of surgical data, the ratio of 50.8%vs 11.7T / P0.001 in PPM group was significantly higher than that in non-PPM group, and the ratio of bypass graft (5.8 vs 1.9) and atrial fibrillation (15.9%vs 8.7) was significantly higher than that in non-PPM group. P0. 005) the ratio of combined operation was relatively high. Binary logistic regression analysis showed that old age (P0. 011), large body surface area (P0. 001), biological flap (P0. 001) and left ventricular end diastolic diameter (P0. 001) were the risk factors of PPM. There was no significant difference in postoperative complications between the two groups. Nine patients died and the mortality rate was 0.84.The logistic regression analysis showed that PPM was not the influencing factor of short-term postoperative mortality (P0. 654). The follow-up results showed that the heart function of PPM group and non-PPM group were about 9%, and there was no significant difference in heart function between middle and short term (9.6vs9.00.902). Conclusion there is a significant correlation between PPM in mitral valve position and advanced age, biological valve replacement, surface area and left ventricular end-diastolic diameter, but mitral valve PPM has no significant effect on the short and medium term prognosis of mitral valve replacement. The mitral stenosis ratio is high in East China, so whether the PPM standard can be applied to the patients in this area remains to be further explored.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R654.2
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