目的:探讨不同抗凝强度华法林应用于非瓣膜性心房颤动患者的可行性及安全性。方法:91例非瓣膜性心房颤动患者随机分为三组:低抗凝强度[国际标准化比率(INR)1.5~1.9];标准抗凝强度组(INR 2.0~2.5)和阿司匹林组,观察三组血栓栓塞并发症和出血等不良反应的发生率以及C反应蛋白浓度变化。结果:标准抗凝强度组血栓发生率低于低抗凝强度组、阿司匹林组,不同强度华法林抗凝组血栓栓塞率比较差异无统计学意义;标准抗凝强度组出血发生率低于其他两个组,但三组患者出血发生率比较无统计学意义(Pgt;0.05);治疗后低抗凝强度组、标准抗凝强度组C反应蛋白浓度明显低于治疗前(Plt;0.05),治疗后阿司匹林组C反应蛋白水平明显高于低抗凝强度组、标准抗凝强度组(Plt;0.01)。结论:华法林抗凝维持INR值在2.0~2.5时能降低非瓣膜性房颤患者血栓栓塞发生率,出血发生率低,有效性和安全性好。
Objective To conduct a systematic review to evaluate preoperative and postoperative changes of echocardiography indexes which reflect left ventricular morphology and contractile function after heart valve replacement of patients with valvular heart disease with giant left ventricle. Methods We electronically searched CBMdisc, VIP database,Wanfang database, CNKI database, PubMed and ScienceDirect from time of establishment of each database to June 2012 to identify literatures addressing heart valve replacement for patients with valvular heart disease and giant left ventricle. Quality of included literatures was evaluated, and relevant data were extracted to conduct meta-analysis. Preoperative and postoperative changes of echocardiography indexes of patients undergoing heart valve replacement were compared. R2.15.2 software was used for statistical analysis. Results Twelve retrospective cohort studies were included in this study involving 833 patients. The quality of included literature was relatively high. Meta-analysis showed that left ventricular end-diastolic diameter (LVEDD) at 2 weeks, 6 months, 1 year, 2 to 3 years postoperatively were reduced by 11.72 mm[95% CI (9.52,13.92), P<0.001], 20.02 mm [95% CI (18.28, 21.76), P<0.001], 22.48 mm [95% CI (19.55, 25.40), P<0.001] and 24.69 mm [95% CI (22.21, 27.18), P<0.001] respectively compared with preoperative value. Left ventricularend-systolic diameter (LVESD) at 2 weeks, 6 months, 1 year, 2 to 3 years postoperatively were reduced by 7.74 mm [95% CI (3.76, 11.72), P<0.001], 15.54 mm [95% CI (12.55, 18.54), P<0.001], 18.84 mm [95% CI (15.54, 21.14),P<0.001] and 21.02 mm[95% CI (17.67, 24.37), P<0.001] respectively compared with preoperative value. Compared with preoperative value, left ventricular ejection fraction (LVEF) decreased by 7% at 2 weeks postoperatively [95% CI (1%, 12%), P=0.013], increased by 9% at 6 months postoperatively [95% CI (-14%, -3%), P=0.002], increased by 11% at 1 year postoperatively [95% CI (-22%, 0%), P=0.041], and increased by 13% at 2-3 years postoperatively [95% CI (4%, 21%), P=0.004]. Compared with preoperative value, left ventricular fraction shortening (LVFS) decreased by 0.05 at 2 weeks postoperatively [95% CI (0.03, 0.07), P<0.001], increased by 0.02 at 6 months postoperatively [95% CI (0.00, 0.04), P=0.055], increased by 0.03 at 1 year postoperatively [95% CI (0.00, 0.06), P=0.035], and increased by 6% at 2-3 years postoperatively [95% CI (0.02, 0.11), P=0.008]. Conclusions LVEED and LVESD of patients with valvular heart disease and giant left ventricle continuously decrease after heart valve replacement, especially in the first 6 months postoperatively, and return to normal in 2 to 3 years. LVEF and LVFS decrease in the first 2 weeks postoperatively, then start to increase, are higher than preoperative values at 6 months, and return to normal in 2 to 3 years. Heart valve replacement is conducive for the recovery of left ventricular morphology and systolic function of patients with valvular heart disease and giant left ventricle.
Objective To explore clinical application and significance of coronary angiography (CAG) prior to heart valve replacement for patients with rheumatic valvular heart disease (RVHD). Methods We retrospectively analyzed clinical data of 313 RVHD patients who underwent heart valve replacement in the First Affiliated Hospital of Chongqing Medical University from January 2002 to June 2012. All the patients received screening CAG before surgery. According to CAG results,313 patients were divided into two groups. In the coronary artery lesion (CAL) group,there were 29 patients including 17 male and 12 female patients with their age of 60.0±5.2 years. In the non-coronary artery lesion (non-CAL)group,there were 284 patients including 98 male and 186 female patients with their age of 57.0±5.4 years. Surgicaloutcomes were compared between the two groups. Univariate analysis and multivariate logistic regression were performed to analyze risk factors of CAL for RVHD patients. Results CAG showed 29 patients with CAL,and the overall prevalence of CAL was 9.27%. In CAL group,11 patients underwent concomitant coronary artery bypass grafting with 2.2 grafts for each patient on the average. Postoperatively 1 patient (3.45%) died of low cardiac output syndrome (LCOS). In non-CAL group,5 patients (1.76%) postoperatively died mainly because of LCOS,ventricular fibrillation,sudden cardiac arrest or respiratory failure. Cardiopulmonary bypass time and aortic cross-clamp time of CAL group were significantly longer than those of non-CAL group (P<0.05). There was no statistical difference in postoperative mortality,incidence of LCOS,acute renal failure,respiratory failure,reexploration for bleeding,intraoperative blood loss,mechanical ventilation time or hospital stay between the two groups(P>0.05). There was no significant correlation between the types of valvular lesions and CAL. Age≥ 55 years (OR=5.534,P=0.005),male gender (OR=2.335,P=0.038) and diabetes mellitus (OR=4.265,P=0.006) were independent risk factors of CAL for RVHD patients undergoing heart valve replacement. Conclusion For RVHD patients with independent risk factors of CAL (age≥55 years,male gender and diabetes mellitus),CAG must beseriously considered before heart valve replacement. RVHD patients with CAL can obtain similarly satisfactory surgicaloutcomes of heart valve replacement as RVHD patients without CAL by appropriate surgical strategy and strengthened perio-perative management.
Abstract: Quality of life (QOL) refers to an individual’s perception and subjective evaluation of their health and well-being, and has become an important index to evaluate the outcomes of clinical treatment in the last past decades. There are a large number of different instruments to evaluate QOL, and the 36-Item Short Form Health Survey (SF-36) is currently one of the most widely used instruments. In recent years, SF-36 has been used to evaluate QOL of valvular heart disease patients to investigate the risk factors those influence their postoperative QOL, provide more preoperative evaluation tools for clinical physicians, and improve postoperative outcomes of patients with valvular heart disease. However, it is now just the beginning to use SF-36 to examine QOL of valvular heart disease patients. Because of significant differences in sample size, follow-up period, country and culture, current research has some controversial results. This review focuses on the progress in evaluating QOL in postoperative patients with valvular heart disease using SF-36.