心脏瓣膜手术后早期住院死亡相关危险因素分析

Analysis on risk factors of early postoperative death in patients undergoing valvular surgery

目的探讨影响心脏瓣膜手术后早期住院死亡相关危险因素。方法 2001年1月—2010年11月,618例心脏瓣膜疾病患者在我科行手术治疗,其中男339例,女279例,年龄10-74(44.01±13.95)岁;风湿性心脏病387例,非风湿性心脏病231例;以手术后早期住院死亡为研究终点,采用单因素及多因素logistic回归方法分析术后早期死亡的危险因素。结果心脏瓣膜术后早期住院死亡率6.2%(38/618),死亡原因依次为低心排综合征,室性心律失常,多器官功能衰竭。单因素分析显示,年龄≥65岁(P=0.000)、心功能Ⅳ级(P=0.000)、肺动脉高压≥60 mmHg(P=0.024)、体外循环时间≥3 h(P=0.000)、主动脉阻断时间≥2 h(P=0.000)、术后出现并发症(P=0.011)、输血量≥2 000 ml(P=0.000)是瓣膜手术后早期死亡的危险因素。多因素Logistic回归分析示年龄≥65岁(P=0.042)、心功能Ⅳ级(P=0.019)、体外循环时间≥3 h(P=0.000)、术后出现并发症(P=0.000)、输血量≥2 000 ml(P=0.000)是瓣膜手术后早期死亡的独立危险因素。结论重视心脏瓣膜术后早期死亡的独立危险因素处理,缩短体外循环时间,减少并发症,对降低瓣膜手术的死亡率具有重要的临床意义。

Objective To analyze risk factors associated with early postoperative death in patients with valvular surgery. Methods Form January 2001 to November 2010, clinical data of 618 patients, including 339 male, 279 famele, age 10 -74 （44.01±13.95 ） undergoing valvular operations were investigated retrospectively. Its risk factors were evaluated by univariate and multivariate logistic regression analysis with SPSS software. Results The hospital mortality of valvular surgery was 6.2% （38/618）. The reason of death was in turn low cardiac output syndrome, ventricular arrhythmia and multiple organ dysfunction or failure. Univariate risk factor included age ≥65 y （ P = 0.000）, NYHA functional class Ⅳ （ P = 0.000）, pulmonary hypertension （ P = 0. 024 ）, cardiopulmonary bypass time ≥3h （P = 0. 000）, aortic cross clamping time≥2h （P = 0.000）, postoperative complications （P = 0. 011 ） and blood transfusion ≥2000ml （ P = 0. 000） were important risk factors for early postoperative death. Multivariate logistic regression showed that age ≥65y （ P = 0.042）, NYHA functional class Ⅳ （ P = 0.019 ）, postoperative complications （ P = 0. 000）, and blood transfusion ≥2000ml （ P = 0. 000） were significant independent predictive risk factors. Conclusion This study suggests that patients with predictive risk factors of early postoperative death need more carefully treated. The hospital mortality of these patients would be reduced through improving perioperative management, shortening eardiopulmonary bypass time and reducing post-operative complications.