心内直视瓣膜置换术中心脏自动复跳的影响因素研究
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摘要
背景心内直视瓣膜置换术是治疗心脏瓣膜病的主要手段,而术中复温阶段心脏能否自动复跳常关系到手术的成败,其影响因素一直备受临床关注。目的探讨心内直视瓣膜置换术中心脏自动复跳的影响因素。方法选取2017年9月—2018年7月安徽省立医院收治的心脏瓣膜病并行心内直视瓣膜置换术患者413例,按照术中复温阶段心脏是否自动复跳分为自动复跳组(n=254)和非自动复跳组(n=159)。比较两组患者性别,年龄,体质指数(BMI),高血压、糖尿病、肾功能不全、呼吸系统疾病、血栓性疾病、房室传导阻滞发生情况,左心室舒张末期内径(LVEDD),左心室后壁厚度(LVPWT),肺动脉收缩压(PASP),左心室射血分数(LVEF),手术方式〔包括二尖瓣置换术(MVR)、主动脉瓣置换术(AVR)、二尖瓣联合主动脉瓣置换术(DVR)〕,主动脉阻断时间,术中输库存血量;心内直视瓣膜置换术中心脏自动复跳的影响因素分析采用二元Logistic回归分析。结果两组患者年龄,BMI,高血压、糖尿病、呼吸系统疾病、房室传导阻滞发生率,PASP,主动脉阻断时间,术中输库存血量比较,差异无统计学意义(P>0.05);两组患者性别、肾功能不全及血栓性疾病发生率、LVEDD、LVPWT、LVEF、手术方式比较,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,肾功能不全〔OR=5.630,95%CI(1.342,23.612)〕、LVPWT≥13 mm〔OR=2.249,95%CI(1.103,4.583)〕、LVEF<50%〔OR=3.164,95%CI(1.732,5.780)〕、AVR〔OR=2.717,95%CI(1.456,5.071)〕、DVR〔OR=2.581,95%CI(1.427,4.665)〕是心内直视瓣膜置换术中心脏自动复跳的危险因素(P<0.05)。结论肾功能不全、LVPTW≥13 mm、LVEF<50%、涉及主动脉瓣置换的术式是心内直视瓣膜置换术中心脏复跳的危险因素,临床应加以重视。
Background Open-heart valve replacement is the main therapeutic measure of valvular heart disease,however intraoperative automatic heart resuscitation at rewarming stage has significant influence on the surgical success or failure,and its influencing factors attract much clinical attention. Objective To explore the influencing factors of automatic heart resuscitation during open-heart valve replacement. Methods A total of valvular heart disease patients underwent openheart valve replacement were selected in Anhui Provincial Hospital from September 2017 to July 2018,and they were divided into A group(with automatic heart resuscitation,n=254)and B group(without automatic heart resuscitation,n=159)according to the incidence of intraoperative automatic heart resuscitation at rewarming stage. Gender,age,BMI,incidence of hypertension,diabetes,renal insufficiency,respiratory disease,thrombosis disease and atrioventricular block,LVEDD,LVPWT,PASP,LVEF,surgical procedures〔including mitral valve replacement(MVR),aortic valve replacement(AVR)and double valves replacement(DVR)〕,aortic-cross clamping time and intraoperative stored blood transfusion volume were compared between the two groups;binary Logistic regression analysis was used to analyze the influencing factors of automatic heart resuscitation during open-heart valve replacement. Results There was no statistically significant difference in age,BMI,incidence of hypertension,diabetes,respiratory disease or atrioventricular block,PASP,aortic-cross clamping time or intraoperative stored blood transfusion volume between the two groups(P>0.05),while there were statistically significant differences of gender,incidence of renal insufficiency and thrombosis disease,LVEDD,LVPWT,LVEF and surgical procedures between the two groups(P<0.05). Binary Logistic regression analysis results showed that,renal insufficiency〔OR=5.630,95%CI(1.342,23.612)〕,LVPWT5.780)〕,AVR〔OR=2.717,95%CI(1.456,5.071)〕and DVR〔OR=2.581,95%CI(1.427,4.665)〕were risk factors of automatic heart resuscitation during open-heart valve replacement(P<0.05). Conclusion Renal insufficiency,LVPWT ≥ 13 mm,LVEF<50% and surgical procedures involving aortic valve replacement are risk factors of automatic heart resuscitation during open-heart valve replacement,which should be pay more clinical attention to.
Background Open-heart valve replacement is the main therapeutic measure of valvular heart disease,however intraoperative automatic heart resuscitation at rewarming stage has significant influence on the surgical success or failure,and its influencing factors attract much clinical attention. Objective To explore the influencing factors of automatic heart resuscitation during open-heart valve replacement. Methods A total of valvular heart disease patients underwent openheart valve replacement were selected in Anhui Provincial Hospital from September 2017 to July 2018,and they were divided into A group(with automatic heart resuscitation,n=254)and B group(without automatic heart resuscitation,n=159)according to the incidence of intraoperative automatic heart resuscitation at rewarming stage. Gender,age,BMI,incidence of hypertension,diabetes,renal insufficiency,respiratory disease,thrombosis disease and atrioventricular block,LVEDD,LVPWT,PASP,LVEF,surgical procedures〔including mitral valve replacement(MVR),aortic valve replacement(AVR)and double valves replacement(DVR)〕,aortic-cross clamping time and intraoperative stored blood transfusion volume were compared between the two groups;binary Logistic regression analysis was used to analyze the influencing factors of automatic heart resuscitation during open-heart valve replacement. Results There was no statistically significant difference in age,BMI,incidence of hypertension,diabetes,respiratory disease or atrioventricular block,PASP,aortic-cross clamping time or intraoperative stored blood transfusion volume between the two groups(P>0.05),while there were statistically significant differences of gender,incidence of renal insufficiency and thrombosis disease,LVEDD,LVPWT,LVEF and surgical procedures between the two groups(P<0.05). Binary Logistic regression analysis results showed that,renal insufficiency〔OR=5.630,95%CI(1.342,23.612)〕,LVPWT5.780)〕,AVR〔OR=2.717,95%CI(1.456,5.071)〕and DVR〔OR=2.581,95%CI(1.427,4.665)〕were risk factors of automatic heart resuscitation during open-heart valve replacement(P<0.05). Conclusion Renal insufficiency,LVPWT ≥ 13 mm,LVEF<50% and surgical procedures involving aortic valve replacement are risk factors of automatic heart resuscitation during open-heart valve replacement,which should be pay more clinical attention to.
引文
[1]高润霖.中国心瓣膜病现状[J].华西医学,2018,33(2):127-131.DOI:10.7507/1002-0179.201712108.
[2]杨慧,姜静,秦巍.心脏手术中心脏复苏困难的处理[J].黑龙江医学,2006,30(1):1-2.DOI:10.3969/j.issn.1004-5775.2006.01.001.
[3]徐长宪,郭兰敏,宋惠民,等.心内直视手术后心脏复苏困难的原因和紧急处理措施[J].中国急救医学,2002,22(11):670-671.DOI:10.3969/j.issn.1002-1949.2002.11.036.
[4]颜海强.心脏瓣膜病治疗的现状与发展[J].福建医药杂志,2014,36(2):140-141.
[5]刘志勇,孙根义.心肾综合征发病机制及治疗研究进展[J].中国循证心血管医学杂志,2011,3(5):385-387.DOI:10.3969/j.issn.1674-4055.2011.05.021.
[6]仇冰梅,孙磊,张晓华,等.术前伴有严重肾功能不全的患者围术期管理经验[J].中国体外循环杂志,2016,14(4):229-232.DOI:10.13498/j.cnki.chin.j.ecc.2016.04.10.
[7]石芸萍.促红细胞生成素的研究进展[J].疾病监测与控制,2016,10(3):202-203.
[8]韩额尔德木图,马月宏,王海燕,等.慢性心衰的病理生理及发病机制研究进展[J].中西医结合心脑血管病杂志,2016,14(12):1349-1352.DOI:10.3969/j.issn.1672-1349.2016.12.013.
[9]赵艳,孔航,杨琴.体外循环下心内直视手术术中心脏复跳困难临床分析[J].第三军医大学学报,2008,30(19):1865-1866.DOI:10.3321/j.issn:1000-5404.2008.19.027.
[10]GIL K E,PAWLAK A,FRONTCZAK-BANIEWICZ M,et al.The proposed new classification of coronary microcirculation as the predictor of the heart failure progression in idiopathic dilated cardiomyopathy[J].Cardiovasc Pathol,2015,24(6):351-358.DOI:10.1016/j.carpath.2015.08.001.
[11]胡志斌,毛文帅,葛根贤,等.体外循环下心内直视术中心脏复跳困难6例处理体会[J].实用医学杂志,2013,29(5):794-796.DOI:10.3969/j.issn.1006-5725.2013.05.043.
[12]赵凤华,齐弘炜,吴明营,等.重度主动脉瓣狭窄瓣膜置换术中的心肌保护[J].中国体外循环杂志,2009,7(1):33-35.DOI:10.3969/j.issn.1672-1403.2009.01.010.
[13]武云涛,田国祥,张薇,等.血管内皮功能失调与冠心病急性缺血发作的机制探讨[J].中国循证心血管医学杂志,2018,10(7):670-671.DOI:10.3969/j.issn.1674-4055.2018.07.32.
[14]KHONSARI S,SINTEK C F.心脏外科手术技术安全措施与失误防范[M].周睿,朱红生,译.上海:上海科学技术出版社,2011.
[15]陈林,肖颖彬,肖娟,等.不同心肌保护方法在双瓣膜置换术中对心肌的保护作用[J].中国胸心血管外科临床杂志,2012,19(4):371-375.DOI:10.3969/j.issn.1672-9463.2012.12.015.
[16]龚庆成,董培普,陈宝田,等.长时间心肌血运阻断心脏手术的心肌保护临床经验[J].心肺血管学报,1991,10(3):215-217.
[2]杨慧,姜静,秦巍.心脏手术中心脏复苏困难的处理[J].黑龙江医学,2006,30(1):1-2.DOI:10.3969/j.issn.1004-5775.2006.01.001.
[3]徐长宪,郭兰敏,宋惠民,等.心内直视手术后心脏复苏困难的原因和紧急处理措施[J].中国急救医学,2002,22(11):670-671.DOI:10.3969/j.issn.1002-1949.2002.11.036.
[4]颜海强.心脏瓣膜病治疗的现状与发展[J].福建医药杂志,2014,36(2):140-141.
[5]刘志勇,孙根义.心肾综合征发病机制及治疗研究进展[J].中国循证心血管医学杂志,2011,3(5):385-387.DOI:10.3969/j.issn.1674-4055.2011.05.021.
[6]仇冰梅,孙磊,张晓华,等.术前伴有严重肾功能不全的患者围术期管理经验[J].中国体外循环杂志,2016,14(4):229-232.DOI:10.13498/j.cnki.chin.j.ecc.2016.04.10.
[7]石芸萍.促红细胞生成素的研究进展[J].疾病监测与控制,2016,10(3):202-203.
[8]韩额尔德木图,马月宏,王海燕,等.慢性心衰的病理生理及发病机制研究进展[J].中西医结合心脑血管病杂志,2016,14(12):1349-1352.DOI:10.3969/j.issn.1672-1349.2016.12.013.
[9]赵艳,孔航,杨琴.体外循环下心内直视手术术中心脏复跳困难临床分析[J].第三军医大学学报,2008,30(19):1865-1866.DOI:10.3321/j.issn:1000-5404.2008.19.027.
[10]GIL K E,PAWLAK A,FRONTCZAK-BANIEWICZ M,et al.The proposed new classification of coronary microcirculation as the predictor of the heart failure progression in idiopathic dilated cardiomyopathy[J].Cardiovasc Pathol,2015,24(6):351-358.DOI:10.1016/j.carpath.2015.08.001.
[11]胡志斌,毛文帅,葛根贤,等.体外循环下心内直视术中心脏复跳困难6例处理体会[J].实用医学杂志,2013,29(5):794-796.DOI:10.3969/j.issn.1006-5725.2013.05.043.
[12]赵凤华,齐弘炜,吴明营,等.重度主动脉瓣狭窄瓣膜置换术中的心肌保护[J].中国体外循环杂志,2009,7(1):33-35.DOI:10.3969/j.issn.1672-1403.2009.01.010.
[13]武云涛,田国祥,张薇,等.血管内皮功能失调与冠心病急性缺血发作的机制探讨[J].中国循证心血管医学杂志,2018,10(7):670-671.DOI:10.3969/j.issn.1674-4055.2018.07.32.
[14]KHONSARI S,SINTEK C F.心脏外科手术技术安全措施与失误防范[M].周睿,朱红生,译.上海:上海科学技术出版社,2011.
[15]陈林,肖颖彬,肖娟,等.不同心肌保护方法在双瓣膜置换术中对心肌的保护作用[J].中国胸心血管外科临床杂志,2012,19(4):371-375.DOI:10.3969/j.issn.1672-9463.2012.12.015.
[16]龚庆成,董培普,陈宝田,等.长时间心肌血运阻断心脏手术的心肌保护临床经验[J].心肺血管学报,1991,10(3):215-217.