合并巨大左心室的老年心脏瓣膜病患者心脏瓣膜术后发生低心排综合征的危险因素分析  

Risk factors of low cardiac output syndrome after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle

作　　者：李昭 张国报 李廷武 张瑜 李梦蝶 吴月 Li Zhao;Zhang Guobao;Li Tingwu;Zhang Yu;Li Mengdie;Wu Yue(Department of Cardiovascular Surgery,Henan Provincial People′s Hospital,Fuwai Central China Cardiovascular Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China;Intensive Care Unit of Children′s Heart Center,Henan Provincial People′s Hospital,Fuwai Central China Cardiovascular Hospital,People′s Hospital of Zhengzhou University,Zhengzhou 450003,China)

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

出　　处：《中华心血管病杂志》2021年第4期368-373,共6页Chinese Journal of Cardiology

基　　金：河南省医学科技攻关计划省部共建项目(SB201902032)。

摘　　要：目的:探讨合并巨大左心室的老年心脏瓣膜病患者心脏瓣膜术后发生低心排综合征(LCOS)的危险因素。方法:本研究为回顾性研究,收集2016年1月至2020年1月在河南省人民医院(阜外华中心血管病医院)行心脏瓣膜术且年龄≥60岁、合并巨大左心室的心脏瓣膜病患者。根据术后是否发生LCOS,将患者分为LCOS组和非LCOS组。收集纳入患者的临床资料及术前超声心动图检测结果、手术资料。以是否发生LCOS为因变量,单因素分析中有统计学意义的变量为自变量,构建多因素logistic回归方程,分析合并巨大左心室的老年心脏瓣膜病患者术后发生LCOS的危险因素。为分析连续型变量的变化趋势对术后LCOS发生风险的影响,在危险因素中取连续型变量放入回归模型中进行趋势性检验。结果:本研究共纳入112例患者,其中男性76例,年龄(65.3±3.8)岁。LCOS组21例,非LCOS组91例。单因素分析结果显示,两组间年龄≥70岁、术前NYHA心功能Ⅳ级、合并肾功能不全及脑血管疾病、术前LVEF<40%、失血量/总血容量>20%、体外循环时间>130 min、主动脉阻断时间>90 min患者的比例,差异均有统计学意义( P均<0.05)。多因素logistic回归分析结果显示,年龄≥70岁( OR=5.067,95% CI 1.320~19.456, P=0.018)、术前纽约心脏病协会(NYHA)心功能Ⅳ级( OR=3.100,95% CI 1.026~9.368, P=0.045)、合并肾功能不全( OR=3.627,95% CI 1.018~12.926, P=0.047)、体外循环时间>130 min( OR=4.539,95% CI 1.483~13.887, P=0.008)是合并巨大左心室的老年心脏瓣膜病患者心脏瓣膜术后发生LCOS的独立危险因素 。与60~<65岁患者比较,65~<70岁( OR=1.784,95% CI 0.581~5.476)与≥70岁( OR=4.400,95% CI 1.171~16.531)者术后发生LCOS风险升高;随年龄增加,LCOS发生风险呈上升趋势(趋势检验 P=0.024)。与体外循环时间≤90 min患者比较,>90~110 min( OR=1.917,95% CI 0.356~10.322)、>110~130 min( OR=1.437,95% CI 0.114~18.076)及>130 min( OR=5.750,Objective To explore the risk factors of low cardiac output syndrome(LCOS)after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle.Methods This was a retrospective study.The clinical data of patients over 60 years old with giant left ventricle who underwent cardiac valvular surgery in Henan Provincial People′s Hospital(Fuwai Central China Cardiovascular Hospital)from January 2016 to January 2020 were collected in this study.Patients were divided into LCOS group and non-LCOS group.The clinical data,preoperative echocardiographic results and surgical data of all patients were collected.Taking LCOS as dependent variable and statistically significant variables in univariate analysis as independent variable,multivariate logistic regression equation was constructed to identify the risk factors of LCOS after cardiac valvular surgery in elderly patients with valvular disease complicated with giant left ventricle.On the basis of logistic regression,the risk factors of continuous variables were put into the regression model for trend test.Results A total of 112 patients were included,among whom 76 patients were male,the mean age was(65.3±3.8)years.There were 21 cases in LCOS group and 91 cases in non LCOS group.Univariate analysis showed that age≥70 years,preoperative NYHA cardiac function classⅣ,preoperative renal dysfunction,preoperative cerebrovascular disease,preoperative LVEF<40%,blood loss/total blood volume>20%,cardiopulmonary bypass(CPB)time>130 minutes and aortic cross-clamp time>90 minutes all had statistically significant differences between the two groups(all P<0.05).Multivariate logistic regression analysis showed that age≥70 years(OR=5.067,95%CI 1.320-19.456,P=0.018),preoperative NYHA cardiac function classⅣ(OR=3.100,95%CI 1.026-9.368,P=0.045),renal dysfunction(OR=3.627,95%CI 1.018-12.926,P=0.047),CPB time>130 minutes(OR=4.539,95%CI 1.483-13.887,P=0.008)were the independent risk factors of LCOS after cardiac valvular surgery in elderly patients

关 键 词：心脏瓣膜疾病 老年人 巨大左心室 低心排综合征 

分 类 号：R654.2[医药卫生—外科学]