风湿性心脏病二尖瓣置换术前营养风险分析及临床意义

Risk factors and prognosis for rheumatic heart disease with mitral valve replacement patients with preoperative nutritional risk

目的:探讨二尖瓣置换患者术前营养风险状况与围手术期并发症的关系,分析营养风险的危险因素。方法:回顾性分析335例二尖瓣置换术患者的临床资料。根据营养风险评分进行分组,总评分<3分为无营养风险组,总评分≥3分为营养风险组。采用单因素分析术前营养风险状况对围手术期并发症及术后康复时间的影响,多因素Logistic回归分析术前营养风险的独立危险因素。结果:营养风险组176例,无营养风险组159例。营养风险组围手术期并发症发生比例明显高于无营养风险组115例(65.3%)对36例(22.6%),差异有统计学意义(P<0.05);营养风险组与无营养风险组术后严重并发症比较76例(43.2%)对23例(14.5%)、平均住院日比较[(21.52±8.12)vs.(12.32±7.61)d],差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,患者心功能(NYHA)Ⅲ~Ⅳ(OR=1.62,95%CI:1.221~2.354)、入院二尖瓣狭窄程度(OR=6.57,95%CI:5.863~8.412)、入院饮食状况(OR=0.324,95%CI:0.216~0.501)、失眠(OR=0.603,95%CI:0.411~0.916)是发生术前营养风险的独立危险因素(P<0.05)。结论:患者的入院症状重、入院心功能Ⅲ级~Ⅳ级、入院饮食状况和失眠不良的二尖瓣置换患者易发生营养风险,术前NRS2002评分≥3的患者出现使用呼吸机时间延长,ICU滞留时间延长及术后住院超过30d的可能性增大。

Objective ： To investigate the reference basis for reduceing the occurence of nutritional risk by analyzing possible risk factors for nutritional risk status and investigating the relationship between preoperative nutritional risk status and prognosis. Methods： We retrospectively analyzed the clinical data of 335 cases of patients （the nutritional risk group of 176cases, non-the nutritional risk group of 159cases）with mitral valve replacement. The univariate analysis was used to analyze the relationships between nutritional risk status with perioperative complications and length hospitalization. And multiple Logistic regression analysis was applied to analize the risk factors of nutritional risk status. Results： The nutritional risk group had a higher rate of postoperative complications （65.34% vs. 22. 6% ）, higher incidence of serious complications （43.2% vs. 14. 5% ） and longer the＇average hospital stays （21.52 ± 8.12 ） vs. （ 12. 32 ± 7.61 ） days than non-the nutritional risk group. The result of multiple Logistic regression analysis showed that the preoperative nutritional risk factors were associted with the patients＇ heart function （NYHA） Ⅲ - Ⅳ（ OR = 1.62,95% CI： 1. 221-2. 354 ）, mitral stenosis＇ severity （ OR =6.57,95% CI：5. 863 -8.412）, dietary intake （ OR =0. 324,95% CI：0. 216- 0. 501 ）, insomnia （ OR = 0. 603,95 % CI：0. 411 - 0. 916, P 〈 0. 05 ）. Conclusion： The patients were more severe symtoms, cardiac function level Ⅲ-Ⅳ, insomnia and poor diet are more likely to suffer from nutritional risk. Prolonged hospital stay, ICU stays time and postoperative complications were vulnerable to patients with nutritional risk. To sum up, patients with preoperative nutritional risk should be given timely and effective nutrition intervention measures to reduce postoperative complications and length of hospitalization.