严重左心功能不全患者心脏手术后早期死亡危险因素分析  

Risk Factors of Early Mortality in Patients with Severe Left Ventricular Dysfunction after Cardiac Surgery

作　　者：王肃 黄健昌 臧旺福[1] 周健[1] 丁良福 WANG Su;HUANG Jian-chang;ZANG Wang-fu(The Tenth People's Hospital Affiliated to Tongji University,Shanghai 200072)

机构地区：[1]同济大学附属第十人民医院,上海200072 [2]上海市第十人民医院崇明分院,上海200072

出　　处：《医学临床研究》2020年第10期1504-1507,共4页Journal of Clinical Research

摘　　要：【目的】探讨严重左心功能不全接受心脏手术患者术前情况对术后早期死亡的预测因子。【方法】回顾性分析选取上海市第十人民医院心脏外科2012〜2019年由同一主刀医生完成的符合入选条件心脏手术共106例,所有患者术前心脏彩超左心室射血分数(LVEF)<40%,根据围术期患者生存状况将其分为病死组(n=14)和存活组(n=92)。收集术前临床特征,进行单因素和多因素分析。【结果】经过单因素分析,与术后早期死亡显著相关的危险因素有年龄、体脂质量指数(BMI)、白细胞计数(WBC)、C反应蛋白(CRP)、N氨基末端B型脑钠肽原(NT-proBNP)、手术方式(P<0.1)。结合既往文献,将肌酐(SCr)和肌钙蛋白T(cTnT)也纳入因素进行多因素logistic回归分析。最终发现SCr、WBC、cTnT和手术方式为低射血分数患者术后早期死亡的独立危险因素(均OR>1,P<0.05).【结论】SCr、WBC、cTnT和手术方式为低射血分数患者术后早期死亡的独立危险因素•术前充分评怙此类患者,及时抗炎、营养心肌等治疗,尽量避免急性心肌梗死期给予手术。【Objective】To investigate the predictors of early postoperative mortality in patients with severe left ventricular dysfunction undergoing cardiac surgery.【Methods】A total of 106 eligible cardiac surgeries per formed by the same surgeon from 2012 to 2019 were retrospectively analyzed.All patients were divided into death group(n=14)and survival group(n=92)according to the survival status of perioperative patients.Univariate and multivariate analysis were performed.【Results】Univariate analysis showed that age,body fat mas.s index(BMI),white blood cell count(WBC),C-reactive protein(CRP),N-terminal pro brain natriuretic peptide(NT proBNP)and operation mode were significantly associated with early postoperative death(P<0.1).Combined with previous literature,creatinine(SCr)and troponin T(cTnT)were also included in the multivariate logistic regression analysis.Finally,it was found that SCr,WBC.cTnT and operation mode were independent risk factors for early pexstoperative death in patients with low ejection fraction(all()R〉1,P<0.05).【Conclusion】SCr,WBC»cTnT and surgical methods were independent risk factors for early postoperative death in patients with low ejection fraction.These patients should be fully evaluated before operation»and timely anti-inflammatory,myocardial nutrition and other treatments should be taken to avoid operation in acute myocardial infarction stage.

关 键 词：心室功能 左/外科学 心脏外科手术 危险因素 

分 类 号：R541.42[医药卫生—心血管疾病]