| 摘要: |
| 目的 通过风险调整死亡率的比较,明确主动脉瓣置换术后人工瓣膜-患者不匹配(PPM)程度对患者手术死亡率的影响。方法 回顾性分析第二军医大学长海医院2007年1月1日至2011年12月31日共1 247例主动脉瓣置换术后患者的病例资料,计算患者EuroSCOREⅡ预期死亡率,以患者瓣膜有效开口面积指数将患者分为无或轻度PPM、中度PPM、重度PPM 3组,分别计算各组风险调整死亡率及其95%可信区间。结果 3组患者实际死亡率分别为:无或轻度PPM组2.79%(29/1 040)，中度PPM组5.00%(8/160)，重度PPM组8.51%(4/47)，组间差异有统计学意义(P<0.05)；EuroSCORE Ⅱ预期死亡率分别为:无或轻度PPM组2.82%,中度PPM组2.69%,重度PPM组2.72%,组间差异无统计学意义;风险调整死亡率分别为:无或轻度PPM组0.99(95%可信区间0.93～1.05),中度PPM组1.86(95%可信区间1.68～2.08),重度PPM组3.13(95%可信区间2.56～4.00)，组间差异有统计学意义。结论 主动脉瓣机械瓣置换术后PPM程度的升高可导致死亡风险的增加。 |
| 关键词: 主动脉瓣；人工心脏瓣膜 狭窄 医院死亡率 风险调整 |
| DOI：10.3724/SP.J.1008.2013.00403 |
| 投稿时间：2012-12-25修订日期：2013-01-30 |
| 基金项目:卫生部专项基金(20082096). |
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| Effect of prosthesis-patient mismatch after aortic valve replacement with mechanical valve on operative mortality |
| WANG Lü1,2△,LI Xin1△,QIAO Fan1,XU Zhi-yun1* |
(1. Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
2. Department of Cardiothoracic Surgery, No.252 Hospital of PLA, Baoding 071000, Hebei, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To assess the relationship between early mortality and degree of prosthesis-patient mismatch(PPM) after aortic valve replacement surgery using risk-adjusted mortality of EuroSCORE Ⅱ . Methods The clinical data of 1 247 consecutive patients who underwent aortic valve replacement from Jan. 1, 2007 to Dec. 31, 2011 in our hospital were retrospectively analyzed. The EuroSCORE Ⅱ-predicted mortality and the effective orifice area index (EOAi) of artificial aortic valve were calculated for each patient. The patients were divided into three groups according to aortic EOAi: non-to-mild PPM, moderate PPM, and severe PPM. Risk-adjusted mortality and 95% confidence interval were calculated for each group. The EuroSCORE Ⅱ-predicted mortality and risk-adjusted mortality were compared among three groups. Results The observed mortality was 2.79% (29/1 040) for patients with non-to-mild PPM, 5.00% (8/160) for patients with moderate PPM, and 8.51% (4/47) for patients with severe PPM, with significant differences found between groups (P<0.05) . There were no significant differences in EuroSCORE Ⅱ-predicted mortalities among the three groups (2.82% for the non-to-mild PPM group, 2.69% for the moderate PPM group, and 2.72% for the severe PPM group). And the risk-adjusted mortality of non-to-mild PPM group (0.99, 95%CI: 0.93-1.05) was significantly lower than those of moderate PPM group (1.86, 95%CI: 1.68-2.08) and severe PPM group (3.13, 95%CI: 2.56-4.00). Conclusion High degree of aortic PPM after aortic valve replacement is associated with increased operative mortality. |
| Key words: aortic valve heart valve prosthesis stenosis hospital mortality risk adjustment |
