老年患者心瓣膜置换术后并发室性心律失常危险因素分析及预测模型构建  

Risk factors analysis and predictive model construction of ventricular arrhythmia in elderly patients after cardiac valve replacement

作　　者：余鹏英 蒋礼[1] 张欢 Yu Pengying;Jiang Li;Zhang Huan(Cardiac Surgery Intensive Care Unit,Third People’s Hospital of Chengdu City,Chengdu,Sichuan,610041,P.R.China)

机构地区：[1]成都市第三人民医院心脏外科重症监护室,四川成都610041

出　　处：《老年医学与保健》2022年第3期564-568,573,共6页Geriatrics & Health Care

基　　金：四川省医学科研青年创新课题(Q19056)。

摘　　要：目的探讨老年患者心瓣膜置换术后并发室性心律失常的危险因素,构建室性心律失常的预测模型并验证。方法2019年8月—2022年1月,选取成都市第三人民医院心脏外科重症监护室收治的123例老年心瓣膜置换术患者。通过logistic回归分析术后并发室性心律失常的危险因素,构建预测模型;采用拟合优度检验、受试者操作特征曲线进行模型验证。结果20.33%(25/123)患者术后并发室性心律失常。病程(≥10年)、左室射血分数(<40%)、心胸比例(≥0.7)、三尖瓣关闭不全和主动脉阻断时间(≥90min)是心瓣膜置换术后并发室性心律失常的危险因素(P<0.05)。建立回归方程为logistic(P)=-1.859+0.385X_(1)+0.745X_(2)+0.632X_(3)+0.859X_(4)+0.552X_(5),式中:X_(1)为病程;X_(2)为左室射血分数;X_(3)为心胸比例;X_(4)为三尖瓣关闭不全;X_(5)为主动脉阻断时间。Hosmer-Lemeshow检验方程回归模型拟合优度良好(P=0.338)。预测概率预测术后并发室性心律失常的曲线下面积为0.830,约登指数最大时的预测临界值为1.03,此时灵敏度为96.00%,特异度分别为63.27%。结论病程、左室射血分数、心胸比例、三尖瓣关闭不全以及主动脉阻断时间可能与心瓣膜置换术后并发室性心律失常相关。Objective To explore the risk factors of ventricular arrhythmia after cardiac valve replacement in elderly patients,and construct a predictive model of ventricular arrhythmia and verify it.Methods 123elderly patients who underwent cardiac valve replacement in Cardiac Surgery Intensive Care Unit of Third People’s Hospital of Chengdu City from August2019to January2022were selected.Logistic regression was used to analyze the risk factors of postoperative ventricular arrhythmia,and a predictive model was constructed.The model was verified by goodness of fit test and receiver operating characteristic(ROC)curve.Results 20.33%(25/123)patients suffered from ventricular arrhythmia after operation.Course of disease(≥10years),left ventricular ejection fraction(<40%),cardiothoracic ratio(≥0.7),tricuspid regurgitation and aortic occlusion time(≥90min)were risk factors for ventricular arrhythmia after cardiac valve replacement(P<0.05).The regression equation was established as follows:logistic(P)=-1.859+0.385X_(1)+0.745X_(2)+0.632X_(3)+0.859X_(4)+0.552X_(5);X_(1)was the course of disease,X_(2)was left ventricular ejection fraction,X_(3)was the cardiothoracic ratio,X_(4)was tricuspid regurgitation,X_(5)was aortic occlusion time.Hosmer-Lemeshow test equation regression model had good goodness of fit(P=0.338).The area under the curve of the predicted probability to predict postoperative ventricular arrhythmia was0.830,and the predictive cut-off value was1.03when the Youden index was the largest.At this moment,the sensitivity and specificity were96.00%and63.27%,respectively.Conclusion The course of disease,left ventricular ejection fraction,cardiothoracic ratio,tricuspid regurgitation and aortic occlusion time may be related to ventricular arrhythmia after cardiac valve replacement.

关 键 词：老年人 心瓣膜置换术 室性心律失常 危险因素 

分 类 号：R654.2[医药卫生—外科学]