超声引导下经皮心肌内室间隔射频消融治疗梗阻性肥厚型心肌病术后低血压与体质量指数的相关性研究  

Study on the correlation between postoperative hypotension and body mass index in patients with hypertrophic obstructive cardiomyopathy treated by ultrasound-guided percutaneous intramyocardial septal radiofrequency ablation

作　　者：王慧怡 单博 李静 胡芮 阮方琦 拓胜军 刘丽文 WANG Huiyi;SHAN Bo;LI Jing;HU Rui;RUAN Fangqi;TA Shengjun;LIU Liwen(Department of Ultrasound,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院超声医学科,陕西西安710032

出　　处：《空军军医大学学报》2025年第2期174-180,共7页Journal of Air Force Medical University

基　　金：国家自然科学基金(82230065);空军军医大学临床研究资助计划项目(2021XD010)。

摘　　要：目的 探讨超声引导下经皮心肌内室间隔射频消融术(PIMSRA)治疗梗阻性肥厚型心肌病(HOCM)患者术后低血压(POH)与体质量指数(BMI)的相关性,为围手术期管理提供参考。方法 回顾性收集2016年10月至2022年12月在空军军医大学西京医院肥厚型心肌病诊疗中心接受PIMSRA治疗的337例HOCM患者的临床资料,记录患者术后发生低血压情况以及基线BMI,同时收集患者基线其他一般临床资料、影像学检查以及实验室检验,采用多因素logistic回归分析,明确患者基线BMI与POH的相关性。结果 Liwen POH发生率为11.9%(40/337)。全部病例BMI平均水平为(25.54±3.42) kg/m^(2),发生和未发生POH的病例BMI水平分别为(23.53±3.16) kg/m^(2)和(25.81±3.37) kg/m^(2)(P<0.001)。多模型校正混杂因素后,BMI与POH风险仍存在独立相关性(OR=0.80,95%CI:0.71~0.91,P<0.001)。限制性立方样条模型分析显示,尚不能认为BMI水平与POH风险的关联强度存在非线性剂量-反应关系。排除术中已经发生低血压的患者进行敏感性分析显示,BMI与POH风险的相关性稳定存在。结论 BMI与Liwen治疗的HOCM患者发生POH存在显著负相关关系,提示根据患者基线BMI可为临床制定个体化围手术期血压管理策略提供信息。Objective To investigate the correlation between postoperative hypotension(POH) and body mass index(BMI) in patients with hypertrophic obstructive cardiomyopathy(HOCM) treated by ultrasound-guided percutaneous intramyocardial septal radiofrequency ablation(PIMSRA),and to provide reference for perioperative management.Methods The clinical data of 337 patients with HOCM who underwent PIMSRA in the hypertrophic cardiomyopathy center,Xijing Hospital,Air Force Medical University from October 2016 to December 2022 were retrospectively collected.The incidence of POH and baseline BMI of the patients were recorded.At the same time,other general clinical data,imaging examinations and laboratory tests of patients were collected at baseline.Multivariate logistic regression analysis was used to determine the correlation between baseline BMI and POH.Results The incidence of POH after Liwen procedure was 11.9%(40/337).The mean BMI of all patients was(25.54 ± 3.42) kg/m^(2),and the BMI of patients with and without POH was(23.53 ± 3.16) kg/m^(2) and(25.81 ± 3.37) kg/m^(2),respectively(P<0.001).After adjusting for confounding factors in multiple models,BMI was still independently associated with POH(OR=0.80,95% CI:0.71-0.91,P<0.001).The restricted cubic spline model analysis showed that the nonlinear dose-response relationship between BMI and POH could not be considered.Sensitivity analysis excluding patients who had already developed hypotension during surgery showed a stable correlation between BMI and POH.Conclusion There is a significant negative correlation between BMI and POH in HOCM patients treated with Liwen procedure,suggesting that the baseline BMI of patients can provide reference for clinical development of individualized perioperative blood pressure management strategies.

关 键 词：梗阻性肥厚型心肌病 低血压 围手术期医护 体质量指数 

分 类 号：R654.2[医药卫生—外科学]