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目的分析成人经皮动脉导管未闭(patent ductus arteriosus,PDA)封堵术后发生主动脉瓣关闭不全(aortic regurgitation,AR)的风险、临床相关因素及转归。方法入选101例PDA成年患者,分析PDA封堵术后26例(25.74%)新发生AR或AR程度加重患者的基本临床特征、PDA特征、封堵情况及转归,利用logistic回归模型分析发生AR的危险因素。结果 26例新发生AR或AR程度加重患者与未发生AR患者比较,平均肺动脉压[(46.2±20.7)vs(31.4±17.5)mmHg,1mmHg=0.133kPa]、左心室舒张末期内径[(5.2±0.2)vs(4.2±0.4)cm]、PDA大小[(14.0±6.4)vs(9.0±3.5)cm]、术前有轻度AR患者发生率[38.46%(10/26)vs 18.67%(14/75)]差异均有统计学意义(P<0.05)。Logistic回归分析提示左心室舒张末期内径(OR=33.541,95%CI:5.883~191.235,P=0.000)和PDA大小(OR=7.512,95%CI:1.976~28.564,P=0.003)是AR的独立危险因素。随访期间,26例AR患者中有22例(84.62%)AR愈合,1例于术后第30个月死于进行性加重的AR及心力衰竭。结论左心室舒张末期内径和PDA大小是成人经皮PDA封堵术后发生AR的独立危险因素。大多数AR患者的转归良好。
Objective To analyze the risk, clinical factors and prognosis of aortic regurgitation (AR) after patent ductus arteriosus (PDA) closure in adults. Methods A total of 101 adult patients with PDA were enrolled in this study. The clinical features, PDA characteristics, occlusion and prognosis of 26 patients (25.74%) with newly diagnosed AR or AR after PDA occlusion were analyzed. Logistic regression analysis was used to analyze AR Risk factors. Results The mean pulmonary artery pressure ([(46.2 ± 20.7) vs (31.4 ± 17.5) mmHg, 1mmHg = 0.133kPa], left ventricular end diastolic diameter [(5.2 ± (14.0 ± 6.4) vs (9.0 ± 3.5) cm]. The incidence of preoperative mild AR was 38.46% (10/26) vs 18.67% (14.2 ± 0.4) / 75)] differences were statistically significant (P <0.05). Logistic regression analysis showed that left ventricular end-diastolic diameter (OR = 33.541,95% CI: 5.883-191.235, P = 0.000) and PDA size (OR = 7.512, 95% CI: 1.976-28.564, P = 0.003) Risk factors. During follow-up, 22 of 26 AR patients (84.62%) healed with AR and one died of progressive exacerbation of AR and heart failure at 30 months after surgery. Conclusions Left ventricular end-diastolic diameter and PDA size are independent risk factors for AR after adult PDA closure. Most AR patients have a good prognosis.