风湿性心脏病瓣膜置换术后二次开胸止血的危险因素分析  

Analysis of risk factors of secondary thoracotomy to stop bleeding after rheumatic heart disease valve replacement

作　　者：曹森垚[1] 郭建军[1] 刘丽萍 郭林静[1] Cao Senyao;Guo Jianjun;Liu Liping;Guo Linjing(Department of Cardiothoracic Surgery,First Hospital of Shanxi Medical University,Taiyuan 030001,China;the First Clinical School of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院心胸外科,太原030001 [2]山西医科大学第一临床医学院,太原030001

出　　处：《中华胸心血管外科杂志》2022年第12期736-741,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨风湿性心脏病瓣膜置换术后二次开胸止血的相关危险因素。方法回顾性分析山西医科大学第一医院心外科2013年12月至2020年10月行风湿性心脏病瓣膜置换手术的373例患者临床资料。依据术后是否进行二次开胸止血术分为二次开胸组和对照组。收集患者的相关临床资料,通过单因素和多因素logistic回归分析影响术后二次开胸止血的危险因素。结果373例患者中,二次开胸组62例(16.62%),对照组311例(83.38%)。单因素分析显示,患者的年龄、性别、院前心功能分级、肺动脉压力、血红蛋白、凝血酶原时间、手术时间、合并高血压病、术中输血量与术后二次开胸止血的发生相关,差异有统计学意义(P<0.05)。非条件logistic回归分析结果显示,院前心功能分级、血红蛋白、凝血酶原时间及合并高血压病是导致风湿性心脏病瓣膜置换术后二次开胸止血的危险因素。结论通过有效地控制危险因素,可降低风湿性心脏病瓣膜置换术后二次开胸的发生率,降低二次手术导致的风险。Objective To explore the related risk factors of secondary thoracotomy to stop bleeding after rheumatic heart disease valve replacement.Methods A retrospective analysis of 373 patients in the Department of Cardiac Surgery of the First Hospital of Shanxi Medical University who underwent rheumatic heart disease valve replacement surgery from December 2013 to October 2020.According to whether or not to perform secondary thoracotomy to stop bleeding after operation,they were divided into two thoracotomy case group and control group.Collect the relevant clinical data of the patients,and analyze the risk factors that affect the second postoperative thoracotomy to stop bleeding through univariate and multivariate Logistic regression.Results Among the 373 patients,62 cases(16.62%)were in the secondary thoracotomy group and 311 cases(83.38%)were in the control group.Univariate analysis showed that the patient's age,gender,prehospital cardiac function classification,pulmonary artery pressure,hemoglobin value(Hb),prothrombin time(PT),operation time,combined hypertension,intraoperative blood transfusion and postoperative two The occurrence of secondary thoracotomy to stop bleeding was related,and the difference was statistically significant(P<0.05).The results of unconditional logistic regression analysis showed that prehospital cardiac function classification,Hb,PT,and hypertension are the risk factors leading to secondary thoracotomy to stop bleeding after rheumatic heart disease valve replacement.Conclusion Effective control of risk factors can reduce the incidence of secondary thoracotomy after rheumatic heart disease valve replacement,and reduce the risk caused by secondary operations.

关 键 词：风湿性心脏病 二次开胸 危险因素 

分 类 号：R654.2[医药卫生—外科学]