【摘要】 目的探讨大左心室心脏瓣膜病应用心脏瓣膜置换术治疗的临床效果及其影响因素。方法采用随机抽选法从本院2010年1月~2016年1月期间收治的大左心室心脏瓣膜病患者中抽取60例作为本次研究对象,观察心脏瓣膜置换术后的临床效果及并发症发生情况,并采用Logistic回归分析影响并发症发生的因素。结果60例患者术后死亡2例(3.33%),出现并发症情况42例(70.00%),其中23例(38.33%)是室性心律失常,通过术后15 d的观察,患者心脏形态及功能指标明显降低。通过Logistic单因素回归分析显示,LVEDD>80 mm、LVEF<50%、LAD>60 mm、年龄>50岁、体外循环时间>108 min、风湿性心脏瓣膜病、术前非窦性心律、NYHAⅢ级或Ⅳ级与术后室性心律失常相关,是引起术后室性心律失常的重要危险因素。通过Logistic多因素回归分析显示,术前非窦性心律、NYHAⅢ级或Ⅳ级是引发术后室性心律失常的主要危险因素。结论临床治疗大左心室心脏瓣膜病应用心脏瓣膜置换术治疗能明显改善患者心脏形态及心功能,术后早期死亡率较低,提高了患者远期的生存率。术前非窦性心律、NYHAⅢ级或Ⅳ级是引发术后室性心律失常的主要危险因素,可能会增加患者远期死亡率。更多还原

【Abstract】 Objective To explore the clinical effect and influencing factors of heart valve replacement in patients with large left ventricular valvular heart disease. Methods 60 patients with large left ventricular valvular heart disease admitted in our hospital from January 2010 to January 2016 were randomly selected. The clinical effect of heart valve replacement and the incidence of complications were observed,and the factors that affect the occurrence of complications were analyzed by Logistic regression. Results Of the 60 cases,2 cases were died(3.33%). 42 cases had complications(70.00%), and 23 cases were ventricular arrhythmia(38.33%). After the observation of postoperative 15 days, the patient’s heart morphological and functional indicators were significantly decreased. Logistic univariate regression analysis showed that LVEDD >80 mm, LVEF <50%, LAD >60 mm, age >50 years, cardiopulmonary by pass time >108 min,rheumatic valvular heart disease, preoperative non-sinus rhythm, NYHA class Ⅲ or grade Ⅳ were related with postoperative ventricular arrhythmias, and they were important risk factors of causing postoperative ventricular arrhythmia.Logistic multivariate regression analysis showed that preoperative non-sinus rhythm, NYHA class Ⅲ or grade Ⅳ were major risk factors for postoperative ventricular arrhythmia. Conclusion The treatment of large left ventricular valvular heart disease with heart valve replacement can significantly improve the patient’s cardiac morphology and cardiac function, with low early postoperative mortality, and can improve the long-term survival rate of patients. Preoperative non-sinus rhythm, NYHA class Ⅲ or grade Ⅳ are major risk factors for postoperative ventricular arrhythmia, which may increase long-term mortality in patients.更多还原