心脏瓣膜置换术后肺氧合功能参数与继发性肺动脉高压的关系分析  

Analysis of relationship between parameters of pulmonary oxygenation function and secondary pulmonary hypertension after cardiac valve replacement

作　　者：张振忠 王雷 ZHANG Zhenzhong;WANG Lei(Department of Cardiovascular Surgery,Yuncheng Central Hospital,Yuncheng Shanxi 044000,China)

机构地区：[1]山西省运城市中心医院心血管外科,山西运城044000

出　　处：《新疆医科大学学报》2022年第1期64-69,共6页Journal of Xinjiang Medical University

基　　金：山西省重点研发计划(指南)项目(201803D32E028)。

摘　　要：目的探讨心脏瓣膜置换术后肺氧合功能参数与继发性肺动脉高压(PH)的相关性。方法从2015年6月—2020年10月在山西省运城市中心医院心血管外科就诊的患者中选取139例接受心脏瓣膜置换术患者。患者均在术后24 h经胸超声心动图测量肺动脉收缩压(SPAP),并进行动脉血气分析,计算肺氧合指数(OI)、呼吸指数(RI)、动脉血-肺泡气氧分压比值、肺泡-动脉氧分压差[P(A-a)O_(2)]。根据术后24 h SPAP是否>30 mmHg分为高压组和正常组,对比两组临床资料。以多因素Logistic回归分析法及Pearson相关系数法评价心脏瓣膜病患者置换术后肺氧合功能参数与继发性PH的关系。结果139例患者术后继发性PH发生率为45.32%。高压组术前左心室射血分数(LVEF)、美国纽约心脏病学会心功能(NYHA)分级Ⅳ级占比、N末端B型利钠肽前体(NT-ProBNP)水平与术后24 h OI、动脉血-肺泡气氧分压比值低于正常组,体外循环时间、主动脉阻断时间、手术时间、术后机械通气时间与ICU停留时间均长于正常组,术后24 h SPAP、RI、P(A-a)O_(2)高于正常组(P<0.05)。多因素Logistic回归分析显示,术前LVEF、NYHA分级Ⅳ级、NT-ProBNP水平与术后24 h RI、OI、动脉血-肺泡气氧分压比值、P(A-a)O_(2)均是影响术后继发性PH的独立危险因素(P均<0.05)。Pearson相关性分析显示术后24 h RI、P(A-a)O_(2)与SPAP呈正相关(r=0.520、0.381,P<0.05),OI、动脉血-肺泡气氧分压比值与SPAP呈负相关(r=-0.539、-0.411,P<0.05)。结论心脏瓣膜置换术后继发PH风险较大,且术后24 h RI、OI、动脉血-肺泡气氧分压比值、P(A-a)O_(2)是继发性PH的危险因素,且与SPAP值密切相关。Objective To investigate correlation between parameters of pulmonary oxygenation function and secondary pulmonary hypertension(PH)after cardiac valve replacement.Methods From June 2015 to October 2020,139 patients underwent heart valve replacement were selected from the patients who attended the hospital from June 2015 to October 2020.All patients measured pulmonary artery systolic pressure(SPAP)by transthoracic echocardiography 24 hours after surgery and performed arterial blood gas analysis to calculate pulmonary oxygenation index(OI),respiratory index(RI),arterial blood-alveolar gas oxygen partial pressure ratio,and pulmonary alveolar arterial oxygen partial pressure difference[P(A-a)O_(2)].According to whether the SPAP>30 mmHg at 24 h after operation,the patients were divided into the high pressure group and the normal group,and compared the clinical data of the two groups.Multivariate Logistic regression analysis method and Pearson correlation coefficient method were used to evaluate the relationship between pulmonary oxygenation parameters and secondary PH in patients with heart valve disease after replacement.Results The incidence of postoperative secondary PH in 139 patients was 45.32%.The left heart ejection fraction(LVEF),New York Heart Association classification of cardiac function(NYHA)grade Ⅳ,N-Terminal pro-brain natriuretic peptide(NT-ProBNP)level before operation,OI and arterial blood-alveolar gas oxygen partial pressure ratio at 24 hours after operation of the hypertension group were lower than those of the normal group.The cardiopulmonary bypass time,aortic occlusion time,operation time,postoperative mechanical ventilation time and ICU stay time were longer than those of the normal group,the SPAP,RI and P(A-a)O_(2) of the hypertension group 24 hours after the operation were higher than those of the normal group(P<0.05).Multivariate logistic regression analysis showed that LVEF,NYHA grade Ⅳ and NT-ProBNP level before operation and 24 h RI,OI,arterial blood-alveolar gas oxygen partial pressure

关 键 词：心脏瓣膜置换术 氧合功能 肺动脉高压 

分 类 号：R654.1[医药卫生—外科学]