庄晓东,文晗,黄日华,徐兴浩,张绍钊,熊振宇,廖新学

• 1:中山大学附属第一医院心血管内科

摘要(Abstract)：

目的 探讨二尖瓣钳夹术（MitraClip）后发生后负荷不匹配（AM）的相关危险因素，以早期评估手术风险。方法 本研究为回顾性队列研究，纳入2021年12月至2023年12月在中山大学附属第一医院心血管内科住院的48例因重度二尖瓣反流（MR）行MitraClip手术患者。收集手术患者术前的临床资料、实验室检查、以及术前和术后的彩色多普勒超声心动图检查结果。根据是否发生AM[患者左心室射血分数（LVEF）术后相较于术前减少15%及以上，即dLVEF≤–15%]将患者分为AM组和非AM组。采用单因素及多因素Logistic回归分析MitraClip术患者发生术后AM的相关因素。结果 在48例接受了MitraClip手术的患者中，有14例（29.2%）在术后发生了AM，即AM组。非AM组其整体LVEF较术前有所提高，差异无统计学意义，而AM组较术前有所降低，差异有统计学意义（P=0.019）；无论是AM组还是非AM组，患者整体的左心室舒张末期内径（LVEDd）、左心室舒张末期容积指数（LVEDVi）均较术前减小，但差异均无统计学意义（均P>0.05）。单因素Logistic回归分析显示，C反应蛋白（OR 1.98,95%CI 1.02～3.83）、血小板计数（OR 2.22,95%CI 1.08～4.53）、全身免疫炎症指数（OR 1.96,95%CI 1.03～3.71）与MitraClip手术患者发生AM风险增高相关（均P<0.05），而术前右心房内径较大（OR 0.35,95%CI 0.13～0.93）、合并中重度三尖瓣反流（OR 0.19,95%CI0.05～0.81）的患者，术后发生AM的风险更低（均P<0.05），且在矫正了年龄及性别变量后，这种相关性依然存在。结论 C反应蛋白、血小板水平、全身免疫炎症指数升高与MitraClip手术患者发生AM风险增高相关，而术前右心房内径较大、合并中重度三尖瓣反流的患者，术后发生AM的风险更低。

关键词(KeyWords)： 二尖瓣钳夹术;后负荷不匹配;相关因素;Logistic回归

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（82070384、82370358）

作者(Author): 庄晓东,文晗,黄日华,徐兴浩,张绍钊,熊振宇,廖新学

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