上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

心脏术后继发性三尖瓣关闭不全再次行三尖瓣置换术的危险因素分析

赵金龙,张卫,石,叶伟   

  1. 上海交通大学附属胸科医院心血管外科， 上海 200030
  • 出版日期:2015-09-28 发布日期:2015-09-30
  • 通讯作者: 张卫, 电子信箱: zhangwyyy@citiz.net。
  • 作者简介:赵金龙（1989—）， 男， 硕士生; 电子信箱: qdzjl2008@163.com。

Analysis of risk factors of tricuspid valve replacement for patients with secondary tricuspid regurgitation after cardiac surgery

ZHAO Jin-long, ZHANG Wei, SHI Wei, YE Wei   

  1. Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
  • Online:2015-09-28 Published:2015-09-30

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摘要：

目的  回顾性分析心脏术后三尖瓣关闭不全行三尖瓣置换术死亡危险因素，评价New EuroSCORE Ⅱ对三尖瓣置换术后风险的预测作用。方法  回顾性分析77例心脏术后再次行三尖瓣置换术病例的临床资料，对入选者的临床资料进行单因素及多因素统计学分析。结果  单因素分析显示，术前NYHA Ⅳ级、右心衰、肺动脉压力、总胆红素、肌酐、尿素、尿酸，以及术中体外循环时间、心肌保护液量、升主动脉阻断时间、置换瓣膜大小与术后早期死亡有统计学意义（P<0.05）。术前肌酐升高、无心房颤动是心脏术后再次行三尖瓣置换术早期患者死亡的独立危险因素（P<0.05）。死亡组与非死亡组EuroSCORE评分的差异有统计学意义。结论  心脏术后远期因三尖瓣关闭不全行三尖瓣置换术前要特别注意对肾功能异常患者的准备工作，New EuroSCORE Ⅱ可以作为预测此类手术风险的可靠评分系统。

关键词: 三尖瓣关闭不全, 三尖瓣置换术, 危险因素 , New EuroSCORE Ⅱ

Abstract:

Objective  To retrospectively analyze death risk factors of tricuspid valve replacement for patients with tricuspid regurgitation after cardiac surgery and evaluate the risk prediction of New EuroSCORE Ⅱ after tricuspid valve replacement. Methods  The clinical data of 77 patients who underwent the tricuspid valve replacement after cardiac surgery were retrospectively analyzed and univariate analysis and multivariate analysis were conducted. Results  The univariate analysis showed that NYHA class Ⅳ, right heart failure, elevated pulmonary artery pressure, total bilirubin, creatinine, urea, uric acid, sinus rhythm, cardiopulmonary bypass time, protection fluid, blocking time, and smaller prosthesis during the operation were statistically significant for early postoperative death (P<0.05). Elevated creatinine before operation and absence of atrial fibrillation were independent risk factors of early death of patients undergoing the tricuspid valve replacement after cardiac surgery (P<0.05). The difference of EuroSCORE between the death group and survival group was statistically significant. Conclusion  Attention should be paid to patients with abnormal renal function who will undergo the tricuspid valve replacement after cardiac surgery due to tricuspid regurgitation. New EuroSCORE Ⅱ is a reliable scoring system for predicting the risk of operation.

Key words: tricuspid regurgitation, tricuspid valve replacement, risk factors, New EuroSCORE Ⅱ