成人主动脉瓣置换927例回顾性分析曹翔李先华王强韩林徐志云.docVIP

成人主动脉瓣置换 927 例回顾性分析 曹翔△ 李先华 王强 韩林 徐志云 邹良建* 第二军医大学长海医院胸心外科，上海 20043 △ 作者：曹翔，博士，E-mail: cao.xiang@126.com, 现在南通大学附属医院胸心外科，南通 226001 * 通讯作者（corresponding author）Tel: 021 E-mail: changhzlj@126.com [摘要]目的：探讨近年来本地区主动脉瓣病变的病因构成、变迁及成人主动脉瓣置换手术的早期预后。方法：回顾性分析长海医院20年间927例成人主动脉瓣置换患者的临床资料。 结果：先天性和退行性病变是近年来成人主动脉瓣置换术的主要病因。风湿性和感染性病变比例逐渐下降，而退行性和先天性比例不断上升。后十年内患者的术后呼吸机辅助时间、术后ICU停留时间及术后住院时间均较前十年明显缩短（P0.05）。927例患者中，共有44例发生在院死亡，总的在院死亡率4.7%。死亡率在男女性别间无差异。近15年内患者手术死亡率显著下降，明显低于最初5年的死亡率（P0.05）。结论：主动脉瓣疾病的病因近年来发生了变化。随体外循环、外科技术及术后监护水平在不断进步，成人主动脉瓣置换患者的术后在院死亡率较前下降。 [关键词] 主动脉瓣置换；主动脉瓣疾病；病因；在院死亡率 Aortic valve replacement in adults: a retrospective study of 927 cases. CAO Xiang，li Xian-hua，WANG Qiang，HAN Lin，XU Zhi-yun，ZOU Liang-jian Department of Cardiothoracic Surgery，Changhai Hospital，Second Military Medical University，Shanghai 200433 [Abstract] Objective To investigate the etiology of aortic valve diseases and their shifts, as well as the in-hospital mortality of the adults undergoing aortic valve replacement. Methods We carried out a retrospective statistical analysis on a total of 927 patients, who were identified as adults having aortic valve replacement in Changhai hospital, during the 20-year study period. Results In the past few years, the major cause of the aortic valve disease included congenital disease and degenerative condition . There was a decrease in the proportion of patients with rheumatic or infectious etiology, while an increase in degenerative or congenital etiology. During the last decade, duration of postoperative ventilation, time in the intensive care unit (ICU) and length of postoperative hospital stay reduced significantly compare with those of the first decade (P 0.05). The overall in-hospital mortality was 4.7% (44 of 927 patients). No gender difference was found in operative mortality. The in-hospital mortality have greatly decreased in the past 15 years，lower than that of the first 5 years （P0.05）。Conclusions There was a shift in the causes of aortic valve di