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目的 对儿童二尖瓣置换术(MVR)的中远期结果和预后危险因素进行分析.方法 回顾性研究2003年7月至2014年3月在阜外医院接受二尖瓣置换术的14岁以下患者,通过门诊随诊的方式,记录患者的性别、年龄、手术相关资料以及超声心动图、心电图和X线胸片结果,并对其进行统计学分析.结果 共48例患儿,男、女各24例,年龄8个月15天～13岁9个月22天,平均(9.5±3.9)岁,24例为一期二尖瓣置换术,另24例为再次手术.43例采用机械瓣,5例采用生物瓣.术后30天内的病死率8.3％,并发症发生比例25.0％.随访4.7～ 150.7个月,平均(62.0±42.3)个月.远期病死率9.1％,并发症发生比例9.4％.随访左心室射血分数0.30～0.77,平均0.61 ±0.08.无再次MVR或安装起搏器的病例.患儿术后1、5、10年的生存比例分别为(89.5±4.5)％、(83.0±6.1)％、(77.8±7.6)％.二尖瓣置换术时年龄小于5岁是围手术期发生死亡或并发症的危险因素(OR=8.47,95％ CI:1.36～52.61).围手术期出现并发症是远期出现死亡或并发症的危险因素(OR=9.97,95％CI:1.39～71.76).结论 儿童MVR术后的中远期结果满意,手术时机的把握以及降低围手术期并发症的发生能提高此类患儿的预后.

Objective To study the mid-and long-term outcomes and prognostic risk factors of mitral valve replacement (MVR) in children.Methods Retrospectively studied the cases(＜ 14 years) receiving MVR between July 2003 and March 2014 in our hospital,and recorded the gender,age,operation related data and the results of echocardiography,electrocardiogram and chest X-ray in the out-patient department.Results A total of 48 patients were followed up.Age was 8 months 15 days-13 years 9 months and 22 days,the average was (9.5 ± 3.9) years.24 cases were original operations,others were second operations.43 mechanical valves were used,as well as 5 tissue valves.The mortality was 8.3 ％ and the incidence of complications was 25.0％ during the hospitalization or within 30 days after the operations.Follow-up time was 4.7-150.7 months,the average was(62.0 ± 42.3) months.The long-term mortality was 9.1％,and the incidence of complications was 9.4％.Follow-up of left ventricular ejection fraction was 0.30-0.77,the average was 0.61 ±0.08.There was no redo-MVR or implantation of pace maker.The survival rates of 1 year,5 years and 10 years were (89.5 ± 4.5) ％、(83.0 ± 6.1) ％、(77.8 ±7.6)％,respectively.Children younger than 5 years was the risk factor for perioperative mortality or complications (OR =8.47,95％ CI:1.36-52.61).Children with perioperative complications was the risk factor for long-term mortality or complications(OR =9.97,95％ CI:1.39-71.76).Conclusion The results of children with MVR were satisfactory.To perform MVR in children older than 5 years if possible and to reduce the incidence of perioperative complications could improve the prognosis.