主动脉瓣狭窄患者行主动脉瓣置换术后消化道出血相关危险因素分析

Analysis of the related risk factors of gastrointestinal bleeding in aortic stenosis patients after aortic valve replacement

目的探讨主动脉瓣狭窄患者行主动脉瓣置换术后相关危险因素对消化道出血的影响。方法回顾性分析8877例主动脉瓣狭窄患者行主动脉瓣置换术患者的临床资料,将术后出现消化道出血的35例列为实验组,并据性别、年龄、主动脉瓣狭窄程度、左室平均射血分数、EuroSCORE风险评分随机选取50例作为对照组。分析两组患者术前伴发疾病、术后血液指标、口服药物及并发症等相关因素对术后消化道出血的影响。结果术前伴有脑卒中、慢性阻塞性肺疾病(COPD)、肾损害者,术后消化道出血率增加,与对照组比较,差异有显著性(P<0.05)。实验组术前红细胞、白细胞数、血红蛋白含量低于对照组(P<0.05)。术后凝血酶原时间、国际标准化比值较对照组明显升高(P<0.05)。曾有口服非甾体类抗炎药者较对照组术后消化道出血率增高(P<0.05)。术后并发症中有胸腔积液、心包积血、呼吸机依赖、脑血管疾病者较对照组消化道出血率增加(P<0.05)。结论术前伴有脑卒中、COPD,曾有口服非甾体类抗炎药物史,术后呼吸机依赖、国际标准化比值升高、伴发胸腔积液、心包积血等因素是主动脉瓣狭窄患者行主动脉瓣置换术后消化道出血的相关危险因素。

Objective To explore the aortic stenosis patients after aortic valve replacement surgery related risk factors for gastrointestinal bleeding.Method Totally 8877 patients with aortic stenosis in parallel aortic valve replacement surgery from February 2002 to August 2015 from Beijing An Zhen Hospital affiliated to Capital Medical University were retrospectively analyzed.35 cases of postoperative hemorrhage of digestive tract after aortic valve replacement surgery were included in the experimental group.According to gender,age,degree of aortic stenosis,average left ventricular ejection fraction,EuroSCORE risk score,50 cases were randomly selected as control group.The preoperative diseases,postoperative blood indexes,oral drugs,complications and risk factors of postoperative gastrointestinal bleeding were analyzed and compared between two groups.Result The rate of postoperative gastrointestinal bleeding in preoperative patients with stroke,chronic obstructive pulmonary disease（COPD） or kidney damage was higher than that in control group（P0.05）.In experimental group,the counts of preoperative red blood cells,white blood cells,hemoglobin were lower than that in control group（P0.05）.The postoperative prothrombin time,the International Normalized Ratio were higher than that in control group（P0.05）.The rate of postoperative gastrointestinal bleeding was higher in patients with a history of oral nonsteroidal anti-inflammatory drugs（NSAIDs）than that in control group（P0.05）.The postoperative gastrointestinal bleeding rate were higher in patients with postoperative complications of pleural effusion,hemopericardium,Dysfunctional Ventilatory Weaning Response,cardiovascular or cerebrovascular diseases than that in control group（P0.05）.Conclusion Stroke,COPD,a history of oral nonsteroidal anti-inflammatory drugs（NSAIDs）,international normalized ratio increase,postoperative ventilator dependence,pleural effusion,hemopericardium in preoperative patients are related risk factors for patients with gastrointestinal bleeding undergoing aortic valve replacement.