【作者】 钱希明；

【导师】 钟世镇；

【作者基本信息】 南方医科大学 ， 人体解剖学及组织胚胎学， 2009， 博士

【摘要】 目的本前瞻性研究的主要目的是研究主动脉瓣置换术后远期病人生活质量指数的变化。同时评估瓣膜-病人不匹配是否影响老年人主动脉瓣置换术后改善生活质量。材料与方法使用了前瞻性研究设计。从1995年8月10日到1998年8月19日期间,在我医疗中心实施单纯主动脉瓣置换术或同时施行冠状动脉旁路移植术,且年龄在70岁以上的100例病人列入本研究。病人-瓣膜不匹配被定义为主动脉瓣有效瓣口面积指数小于等于0.85 cm~2/m2。临床随访定期在术后4周、6个月、以后每隔一年进行。收集并比较分析病人长期生存,跨瓣压差等数据;生活质量采用短期健康调查表(SF-36量表)问卷评估。结果病人平均年龄为74.7±5.7岁(范围70-87岁)。平均随访年(7.3±4.7年)。术后三十天死亡率,病人-瓣膜不匹配组6.3%,病人-瓣膜匹配组,3.3%。:在第1年、第3年、第5年随访,病人长期生存率在组间并未表现出显著差异,但第7年随访,病人-瓣膜匹配与不匹配组两组间差异显著。在第1、第5年随访点,心脏超声数据显示病人-瓣膜匹配与不匹配组两组间跨主动脉平均压差差异显著。在随访的大多数点位上,病人的一般健康状况、体力/活力较术前都有所改善。、社会活动、精神健康评估在第三、第五和第七个年头的随访中较术前没有显着改善;而情感、社会活动、尤其是精神健康评估在术后第一年的随访中较术前有非常显著的改善。但组间差异不明显。结论老年患者主动脉瓣置换术后生活质量改善。但在生活质量的改善程度似乎与病人-瓣膜不匹配不相关。病人-瓣膜不匹配对主动脉瓣置换术后临床结果的影响仍然是一个有争议的问题。更多还原

【Abstract】 ObjectivesThe main purpose of this prospective study was to determine if there are differences in changes in QOL scores at long-term postoperatively in elderly patient after aortic valve replacement.An additional aim was to assess whether the prosthesis-patient mismatch impacts the improvement of quality of life in elderly people after aortic valve replacement.MethodsWe used a prospective cohort study design.100 Consecutive patients whose age were more than 70 undergoing isolated aortic valve or simultaneous aortic valve-coronary artery bypass graft(CABG)procedures at our hospital from August 10,1995,through August 19,1998,were identified for enrollment.Patient-prosthesis mismatch(PPM)was defined as the prosthetic aortic valve EOAI was 0.85 cm2/m2 or less.The clinical follow-up was done 4 weeks,6 months after the operation,and at annual intervals.Cumulative and comparative analyses of long-term outcome and gradient pressure of prosthesis valve were performed.The quality of life was evaluated with the Short Form 36-Item Health Survey(SF-36)questionnaire.ResultsMean age at implantation was 74.7±5.7 years(range,70-87 years).Mean follow-up was years(7.3±4.5years).The thirty days mortality is 6.3%in mismatch group,3.3%in no mismatch group.The freedom from death in interval follow-up year didn’t show significant difference between two groups in 1st,third,and fifth follow-up year,but shows significant difference between mismatch and no mismatch group in seventh follow-up year.The echocardiographic data shows significant difference of mean gradient pressure between two groups in the 1st year and 5th year following up.The general health and energy/vitality all improved from preoperative levels at most points of follow-up,there was no significant improvement at the third, fifth,and seventh year follow-up for emotional role,social role,or general mental health.At the first year follow-up,there was some evidence of improvement for the latter 2 categories,with the greater significant improvement in social function,but there is not significant difference between the two groups.ConclusionsQuality of life improved after aortic vale replacement in elderly patients,but Improvements in quality of life appears to be not related PPM.The interpret of PPM impacting Clinic outcome remains a controversial issue.更多还原