第1页共13页大心脏瓣膜置换术治疗大左心室心脏瓣膜病的临床效果[摘要]目的探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15d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>80mm、LVEF60mm、年龄>50岁、体外循环时间>108min、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、第2页共13页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。[关键词]大左心室心脏瓣膜病；心脏瓣膜置换术；影响因素；回归分析[]R542.5；R654.2[文献标识码]B[]1673-9701（2017）11-0068-03ClinicaleffectoflargeheartvalvereplacementinthetreatmentoflargeleftventricularvalvularheartdiseaseWANGZhishengZHANGHuaweiCHENFu'nanWU激anDepartmentofCardiothoracicSurgery，LongyanFirstHospitalAffiliatedtoFu激anMedicalUniversity，Longyan364000，China第3页共13页[Abstract]ObjectiveToexploretheclinicaleffectandinfluencingfactorsofheartvalvereplacementinpatientswithlargeleftventricularvalvularheartdisease.Methods60patientswithlargeleftventricularvalvularheartdiseaseadmittedinourhospitalfromJanuary2010toJanuary2016wererandomlyselected.Theclinicaleffectofheartvalvereplacementandtheincidenceofcomplicationswereobserved，andthefactorsthataffecttheoccurrenceofcomplicationswereanalyzedbyLogisticregression.ResultsOfthe60cases，2casesweredied（3.33%）.42caseshadcomplications（70.00%），and23caseswereventriculararrhythmia（38.33%）.Aftertheobservationofpostoperative15days，thepatient'sheartmorphologicalandfunctionalindicatorsweresignificantlydecreased.Logisticunivariateregressionanalysisshowedthat第4页共13页LVEDD>80mm，LVEF60mm，age>50years，cardiopulmonarybypasstime>108min，rheumaticvalvularheartdisease，preoperativenon-sinusrhythm，NYHAclassⅢorgradeⅣwererelatedwithpostoperativeventriculararrhythmias，andtheywereimportantriskfactorsofcausingpostoperativeventriculararrhythmia.Logisticmultivariateregressionanalysisshowedthatpreoperativenon-sinusrhythm，NYHAclassⅢorgradeⅣweremajorriskfactorsforpostoperativeventriculararrhythmia.ConclusionThetreatmentoflargeleftventricularvalvularheartdiseasewithheartvalvereplacementcansignificantlyimprovethepatient'scardiacmorphologyandcardiacfunction，withlowearlypostoperativemortality，andcanimprovethelong-termsurvivalrateofpatients.Preoperativenon-sinusrhythm，NYHAclassⅢorgradeⅣaremajorriskfactors第5页共13页forpostoperativeventriculararrhythmia，whichmayincreaselong-termmortalityinpatients.[Keywords]Largeleftventricularheartvalvulardisease；Heartvalvereplacement；Influencingfactors；Regressionanalysis心脏瓣膜病是指主动、肺动脉瓣和二尖、三尖瓣的瓣膜因缺血性坏死、黏液变性、退行性改变等导致病变发生，使血流运动受到影响，造成心脏功能出现异常，进而导致心功能衰竭的单瓣膜或多瓣膜发生病变[1-2]。临床常表现为活动后倦怠、疲乏、夜间阵发性呼吸困难、心...