心脏瓣膜置换术后低心排综合征发生情况及影响因素分析  

Analysis of incidence and influencing factors of low cardiac output syndrome after cardiac valve replacement

作　　者：王金龙[1] 吴学艳 李琨[1] 龚茂迪 WANG Jinlong;WU Xueyan;LI Kun;GONG Maodi(Department of Critical Care Medicine,Guizhou Provincial People's Hospital,Guizhou Province,Guiyang 550000,China)

机构地区：[1]贵州省人民医院重症医学科,贵州贵阳550000

出　　处：《中国当代医药》2024年第29期121-124,129,共5页China Modern Medicine

摘　　要：目的分析心脏瓣膜置换术后低心排综合征(LCOS)发生情况及影响因素。方法选取2022年12月至2023年12月贵州省人民医院收治的180例心脏瓣膜置换术患者作为研究对象,根据心脏瓣膜置换术后LCOS发生情况,将发生LCOS与未发生LCOS者分别纳入LCOS组和非LCOS组。采用多因素logistic回归分析LCOS发生的独立影响因素。结果180例心脏瓣膜置换术患者中,术后发生LCOS患者33例,发生率18.33%。单因素分析显示,LCOS组与非LCOS组术前肾功能不全、术后心律失常占比及术前体重指数、术前左心室射血分数(LVEF)、主动脉阻断(ACC)时间、体外循环(CPB)时间、术后呼吸机辅助时间、围手术期失血量的比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,术前肾功能不全(β=1.312,OR=3.714,95%CI:1.602~8.609)、术前LVEF(β=-1.364,OR=0.256,95%CI:0.113~0.577)、ACC时间(β=0.529,OR=1.697,95%CI:1.138~2.532)、CPB时间(β=1.382,OR=3.983,95%CI:1.366~11.613)及术后呼吸机辅助时间(β=0.975,OR=2.651,95%CI:1.234~5.694)为心脏瓣膜置换术后发生LCOS的独立影响因素(P<0.05)。结论术前肾功能不全、术前LVEF、ACC时间、CPB时间及术后呼吸机辅助时间为心脏瓣膜置换术后LCOS发生的独立影响因素,应针对上述因素加强术前评估与围手术期管理。Objective To analyze the incidence and influencing factors of low cardiac output syndrome(LCOS)after cardiac valve replacement.Methods A total of 180 patients with cardiac valve replacement treated in Guizhou Provincial People's Hospital from December 2022 to December 2023 were selected as the study objects.According to the incidence of LCOS af-ter cardiac valve replacement,patients with and without LCOS were included respectively in LCOS group and non-LCOS group.Multiple logistic regression was used to analyze the independent factors affecting the occurrence of LCOS.Results A-mong 180 patients with cardiac valve replacement,33 patients(18.33%)developed LCOS after operation.Univariate analy-sis showed that preoperative renal insufficiency,postoperative arrhythmia rate,preoperative body mass index,preoperative left ventricular ejection fraction(LVEF),aortic cross clamp(ACC)time,cardiopulmonary bypass(CPB)time,postoperative ventilator assistance time and perioperative blood loss were compared between the LCOS group and the non-LCOS group,the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that preoperative re-nal insufficiency(β=1.312,OR=3.714,95%CI:1.602-8.609)and preoperative LVEF(β=-1.364,OR=0.256,95%CI:0.113-0.577),ACC time(β=0.529,OR=1.697,95%CI:1.138-2.532),CPB time(β=1.382,OR=3.983,95%CI:1.366-11.613)and the time of ventilator assistance(β=0.975,OR=2.651,95%CI:1.234-5.694)were independent influencing factors for the occurrence of LCOS after cardiac valve replacement(P<0.05).Conclusion Preoperative renal insufficiency,preopera-tive LVEF,ACC time,CPB time and postoperative ventilator assistance time are independent influencing factors for the oc-currence of LCOS after heart valve replacement,and preoperative evaluation and perioperative management should be strengthened according to these factors.

关 键 词：心脏瓣膜置换术 低心排综合征 影响因素 LOGISTIC回归分析 

分 类 号：R654.2[医药卫生—外科学]