术前营养风险指数对心脏移植手术后患者结局的预测作用

The prediction of preoperative nutritional risk index for the clinical outcomes of the patients underwent homologous orthotopic heart transplantation

目的探讨术前营养风险指数对心脏移植术后4周患者临床结局的预测作用。方法采用连续抽样法选取阜外医院2013年3月至2015年3月间进行同种异体原位心脏移植的成年患者168例,其中男97例,女71例;年龄(44.5±12.7)岁。病因为:瓣膜病5例、冠心病32例、心肌病131例。依据术前营养风险指数分为4组:高营养风险组(12例)、中营养风险组(55例)、低营养风险组(16例)和无营养风险组(85例)。收集患者术后至4周的ICU住院时间、感染和非感染并发症等指标,评价术前营养风险指数对心脏移植患者术后4周临床结局的预测作用。此外,将入选患者按照有、无营养风险分为2组,比较组间各指标差异。结果高、中、低和无营养风险组的感染并发症发生率分别为16.7%、7.3%、6.3%和3.5%;非感染并发症的发生率分别为16.7%、9.1%、6.3%和2.4%;而ICU住院时间分别为(10.9±1.0)天、(7.8±0.5)天、(6.7±0.7)天和(5.9±0.6)天。4组间在感染和非感染并发症发生率以及ICU住院时间方面差异均有统计学意义(P值均<0.05)。有营养风险组和无营养风险组间在这些指标方面的差异有统计学意义(P值均<0.05)。结论术前营养风险指数对同种异体原位心脏移植成年患者的感染、非感染并发症和ICU住院时长等临床结局有预测作用。

Objective To investigate whether the preoperative nutritional risk index(NRI) can predict the clinical outcomes of the patients underwent homologous orthotopic heart transplantation after 4 weeks. Methods With the use of continuous sampling method, a total of 168 adult patients who underwent homologous orthotopic heart transplantation from March 2013 to March 2015 were enrolled in this study. According to the cut-off points of the NRI, the patients were divided into 4 groups(high, moderate, mild and no nutritional risk). 4 weeks after transplantation, the data about the length of stay in ICU, infective and non-infective complications were collected, and the predictive value of the preoperative NRI for the clinical outcomes of the patients underwent homologous orthotopic heart transplantation were evaluated after 4 weeks of operation. In addition, the enrolled patients were divided into 2 groups according to their nutritional risk(with or without), and the differences between the two groups were compared. Results Among the patients, the prevalence of high, moderate, and low nutritional risk was 7.1%, 32.7% and 9.5%, respectively. The prevalence of infective complications for the 4 groups(from high risk to no risk) was 16.7%、7.3%、6.3% and 3.5%, and the corresponding prevalence of non-infective complications was 16.7%、9.1%、6.3% and 2.4%, respectively. In addition, the length of ICU stay of the 4 group was(10.9±1.0)days,(7.8±0.5)days,(6.7±0.7)days and(5.9±0.6)days, respectively. There were significant differences of length of ICU stay, infective and non-infective complications among the 4 groups(P<0.05 for all). Totally, there were significant differences of clinical outcomes between patients with and without nutritional risk(P<0.05 for all). Conclusion Preoperative NRI can predict the clinical outcomes regarding infective and no-infective complications as well as length of ICU stay for the adult patients underwent homologous orthotopic heart transplantation.