巨大左室心脏瓣膜病患者术后发生低心排血量综合征的危险因素分析  

Risk factor analysis of low cardiac output syndrome after heart valve surgery in patients with giant left ventricular

作　　者：李昭 刘鹏 张瑜 李梦蝶 吴月 张国报 LI Zhao;LIU Peng;ZHANG Yu;LI Mengdie;WU Yue;ZHANG Guobao(Department of Cardiovascular Surgery,Fuwai Central China Cardiovascular Hospital,Henan Provincial People′s Hospital(People′s Hospital of Zhengzhou University),Zhengzhou 450003;ICU of Children′s Heart Center,Fuwai Central China Cardiovascular Hospital,Henan Provincial People′s Hospital(People′s Hospital of Zhengzhou University),Zhengzhou 450003)

机构地区：[1]河南省人民医院(郑州大学人民医院)阜外华中心血管病医院心外科,郑州450003 [2]河南省人民医院(郑州大学人民医院)阜外华中心血管病医院儿童心脏中心重症监护室,郑州450003

出　　处：《郑州大学学报（医学版）》2021年第1期89-93,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划省部共建项目(SB201902032)。

摘　　要：目的:探讨巨大左室心脏瓣膜病患者术后发生低心排血量综合征(LCOS)的危险因素。方法:收集接受心脏瓣膜手术的116例巨大左室心脏瓣膜病患者的资料及发生LCOS的情况。采用单因素分析和logistic回归分析筛选术后发生LCOS的危险因素。结果:116例中,19例术后发生LCOS,发生率为16.4%。单因素分析结果显示,主动脉阻断时间>100 min、体外循环时间>140 min、术前心功能Ⅳ级、失血量/总血容量>20%、术前脑钠肽前体>5000 ng/L、术前合并肾功能不全、左室收缩末期内径>60 mm、术前左室射血分数(LVEF)<40%与LCOS的发生有关(P<0.05)。Logistic回归分析显示,体外循环时间>140 min、术前合并肾功能不全、术前LVEF<40%为巨大左室心脏瓣膜病术后发生LCOS的危险因素[β分别为1.157、1.252、1.603,OR(95%CI)分别为3.179(1.067~9.475)、3.496(1.120~10.913)、4.967(1.609~15.335),P<0.05]。结论:体外循环时间>140 min、术前合并肾功能不全、术前LVEF<40%是巨大左室心脏瓣膜病患者术后发生LCOS的危险因素。Aim:To explore risk factors of low cardiac output syndrome(LCOS)after heart valve surgery in patients with giant left ventricular.Methods:The data of 116 patients with giant left ventricular who underwent heart valve surgery were collected for this study,and LCOS occurred in 19 patients.Univariate analysis and logistic regression analysis were used to identify the risk factors for LCOS after heart valve surgery.Results:Among the 116 patients,19 patients developed LCOS,and the incidence was 16.4%.Univariate analysis showed that aortic clamping time>100 min,cardiopulmonary bypass time>140 min,preoperative cardiac function classⅣ,blood loss/total blood volume>20%,preoperative pro-Bnp>5000 ng/L,preoperative renal dysfunction,LVESD>60 mm,and preoperative LVEF<40%were related with LCOS(P<0.05).Logistic regression analysis showed that cardiopulmonary bypass time>140 min,preoperative renal dysfunction,and preoperative LVEF<40%were the risk factors for LCOS after heart valve surgery in patients with giant left ventricular[βwas 1.157,1.252,1.603,OR(95%CI)were 3.179(1.067-9.475),3.496(1.120-10.913),4.967(1.609-15.335),P<0.05].Conclusion:The independent risk factors of LCOS after valvular surgery are cardiopulmonary bypass time>140 min,preoperative renal dysfunction,preoperative LVEF<40%in patients with giant left ventricular.

关 键 词：巨大左室 心脏瓣膜病 低心排血量综合征 危险因素 

分 类 号：R654.2[医药卫生—外科学]