1390例心脏瓣膜病合并肺动脉高压行瓣膜手术疗效分析

摘要

目的:分析心脏瓣膜病变合并肺动脉高压(肺高压)行瓣膜手术的疗效,探讨提高早期生存率的方法.方法:入选1390例行瓣膜置换手术或瓣膜成形术的瓣膜病合并肺高压(肺动脉收缩压≥35 mmHg,1mmHg=0.133 kPa)患者,男性617例( 44.4 %),女性773例( 55.6%).按照肺高压诊断标准将患者肺动脉收缩压(PASP)35～50 mmHg分为轻度肺动脉高压组(轻度组,n= 331),PASP 51～70 mmHg者为中度肺动脉高压组(中度组,n=816),PASP >70 mmHg者为重度肺动脉高压组(重度组,n= 243).回顾性分析1390例患者的临床资料及术前、术中、术后处理方法.结果:.三组术后5～10d肺动脉收缩压比术前降低,左心室射血分数比术前升高,差异均有统计学意义(P<0.05).术后早期(1个月内),中度组比轻度组、重度组比轻度组的术后低心排综合征、肾功能衰竭及呼吸功能不全的发生率均高,差异有统计学意义(P<0.05).术后随访肺动脉收缩压较术前及术后5～10 d均降低,左心室射血分数较术前及术后5～10d均增加,差异均有统计学意义(P<0.05).1369例(98.5%)治愈出院,死亡21例(1.5%),其中轻度组死亡4例(1.2%),中度组死亡12例(1.5%),重度组死亡5例(1.5%).平均随访时间16.5±5.7个月,随访率88.3%(1209例).结论:肺高压是心脏瓣膜手术的危险因素,但只要综合评价病情、注意围手术期心肺保护和积极控制肺高压,手术疗效确切,治愈率高.%Objective: To analyze the surgical effect in patients of heart valve disease combined with pulmonary hypertension and to inprove the early-stage surgical survival rate Methods A total of 1390 patients of heart valve disease combined with pulmonary hypertension received surgery were retrospectively studied and divided into there groups according to pulmonary artery systolic pressure(PASP). Mild group, n=331, the patients had PASP35 ～ 50 mmHg, Medium group, n = 816, the patients had PASP51 ～ 70 mmHg and Severe group, n = 243, the patients PASP＞70 mmHg. We analyzed the clinical features with pre-, peri- and post-operational conditions in all patients among different grups Results: The average followup time was ( 16. 5±5.7 ) months in 1209 patients PASP was decreased and left ventricular ejection fraction was increased 5 ～ 10 days post-operation than which in pre-operation in three groups,P＜0. 05 respectively .The incidence of low cardiac output syndrame, renal failure and respiratory failure were higher in Medium group and Sever group than that in Mild group, P ＜0. 05 respectively 1369 (98. 5％ ) patients were cured and discharged,21 patients( 1.5％ ) died. There were4 (1.2％) death in Mild group, 1 2 death( 1.5 ％ ) in Medium group and5 death(2. 1 ％ ) in Severe group. Conclusion: Pulmonary hypertension was the risk factor for heart valve surgery However; with the accurate clinical analysis proper peri-operative cardiopulmonary protection and actively controlled pulmonary hypertension,the surgical result and the cure rate could be satisfied.