老年患者心脏瓣膜置换术后低心排综合征相关因素的研究

A study on the related factors of low cardiac output syndrome after heart valve replacement in elderly patients

目的探讨老年患者心脏瓣膜置换术后低心排综合征的相关危险因素。方法通过巢式病例对照研究的方法，以年龄≥60岁且行心脏瓣膜置换术患者作为研究队列。根据研究对象在手术术后是否出现低心排综合征分为病例组（n=45）和对照组（n=234）。上述两组均进行临床资料收集，先对相关数据进行单因素分析，再进行两分类Logistic回归分析。结果单因素分析表明，术前动脉压、肾功能不全情况；术中主动脉阻断时间、出血量；术后并发电解质失调、心律失常或多器官功能衰竭等方面组间差异有统计学意义（P〈0．05）。两分类Logistic回归分析表明，失血量／总血容量[比值比（OR）=0．32，P〈0．05]、主动脉阻断时间（OR=1．85，P〈0．05）、电解质失调（OR=1．43，P〈0．05）、心律失常（OR=1．61，P〈0．05）为心脏瓣膜置换术后出现低心排综合征的危险因素。结论患者术前平均动脉压低、术中主动脉阻断时间长、出血量多及术后出现电解质失调、心律律失常、多个器官衰竭情况均为老年患者心脏瓣膜置换术后出现低心排综合征的影响因素，其中主动脉阻断时间、术中出血量、术后出现心律失常及电解质失调等是重要危险因素。

Objective To investigate the related risk factors of low cardiac output syndrome after heart valve replacement in elderly patients. Patients were divided into case group （n = 45 ） and control group （n = 234） according to whether they suffered from low cardiac output syndrome after surgery or not. We collected clinical information among the patients and utilized Univariate analysis, chi-square test and t- test to analyze data, and then used two classification logistic regression analysis to analyze the risk factors which having significant difference in the univariate analysis. Results Univariate analysis showed that preoperative mean arterial pressure, renal insufficiency situation, intraoperative aortic clamping time and the volume of blood loss, postoperative electrolyte imbalance, cardiac arrhythmias and multiple organ failure all had statistically significant differences between two groups （P 〈 0. 05 ）. Two classification logistic regression analysis showed that blood loss/total blood volume [ odds ratio（OR） = 0. 32, P 〈 0.05 ], aortic clamp time （ OR = 1.85, P 〈 0. 05 ）＇, electrolyte disorders （ OR = 1.43, P 〈 0. 05 ）, arrhythmia （ OR = 1.61, P 〈0. 05） are all the risk factors for low cardiac output syndrome after heart valve replacement surgery. Conclusion Preoperative mean arterial blood pressure, intraoperative aortic clamping time, the amount of blood loss and postoperative electrolyte imbalance, cardiac arrhythmias, and multiple organ failure are all the factors which can affect elderly patients with heart valve replacement surgery emerged low cardiac output syndrome or not, among which aortic clamping time, blood loss, postoperative cardiac arrhythmias and electrolyte imbalance are the important risk factors.