术前营养风险指数对心脏机械瓣膜置换手术后患者临床结局的影响

Influence of preoperative nutritional risk index on the clinical outcomes of patients undergoing mechanical heart valve replacement

目的探讨术前营养风险指数(NRI)对心脏机械瓣膜置换术后4周临床结局的影响。方法采用连续抽样法选取汉中市中心医院2016年1月至2019年1月间进行心脏机械瓣膜置换手术的成年患者148例,依据术前营养风险指数分为高营养风险组(HNRI,n=15)、中营养风险组(MNRI,n=31)、低营养风险组(LNRI,n=47)和无营养风险组(NNRI,n=55)。收集患者术后至4周医院内感染、急性肾损伤(AKI)、谵妄、低心排综合征(LCOS)、机械通气>24 h发生率及ICU住院时间。评价术前NRI对心脏机械瓣膜置换患者术后4周临床结局的影响。同时将所有患者按照有、无营养风险分为有营养风险组93例和无营养风险组55例,比较两组间上述各指标的差异。结果高、中、低和无营养风险组患者医院内感染发生率分别为20.00%、16.13%、6.38%和5.45%;AKI发生率分别为20.00%、6.45%、6.38%和5.45%;LCOS发生率分别为33.33%、19.35%、4.26%和3.64%;术后机械通气>24 h发生率分别为66.67%、48.39%、34.04%和18.18%;ICU住院时间分别为(10.3±2.1)d、(7.3±1.9)d、(5.7±2.1)d和(3.1±1.1)d,差异均有统计学意义(P<0.05)。有营养风险组的机械通气>24 h、LCOS、谵妄、AKI、医院内感染发生率及入住ICU平均时间分别为44.09%、13.98%、6.45%、8.60%、11.83%和(6.7±1.9)d,明显高于无营养风险组患者的18.18%、3.64%、3.64%、5.45%、5.45%和(3.1±1.1)d,差异均有统计学意义(P<0.05)。结论随着营养风险指数的增高,心脏机械瓣膜置换成年患者医院内感染、机械通气>24 h、LCOS、谵妄、AKI发生率及ICU住院时间逐渐增加。

Objective To investigate the influence of preoperative nutritional risk index(NRI)on clinical outcomes in the patients who underwent mechanical heart valve replacement after 4 weeks.Methods Using continuous sampling method,a total of 148 adult patients who underwent mechanical heart valve replacement from January 2016 to January 2019 were enrolled in this study.According to the cut-off points of NRI,the patients were divided into 4 groups:high NRI group(HNRI group,n=15),moderate NRI group(MNRI group,n=31),low NRI group(LNRI,n=47),and no nutritional risk(NNRI group,n=55).Four weeks after replacement,nosocomial infections,acute kidney injury,delirium,low cardiac output syndrome(LCOS),mechanical ventilation>24 hours,and the length of stay in ICU were collected.The predictive values of the preoperative NRI for the clinical outcomes of the patients who underwent mechanical heart valve replacement were evaluated after 4 weeks of operation.In addition,the enrolled patients were divided into two groups according to their nutritional risk:with nutritional risk(n=93)or without nutritional risk(n=55),and the differences between the two groups were compared.Results Among the patients,the prevalence of nosocomial infections for high,moderate,low,and no nutritional risk group was 20.00%,16.13%,6.38%,and 5.45%,the prevalence of AKI was 20.00%,6.45%,6.38%,5.45%,and the incidences of low cardiac output syndrome was 33.33%,19.35%,4.26%,3.64%.In addition,the rates of mechanical ventilation>24 hours was 66.67%,48.39%,34.04%,18.18%,and length of ICU stay of the four group was(10.3±2.1)d,(7.3±1.9)d,(5.7±2.1)d,(3.1±1.1)d,respectively.There were significant differences among the four groups(P<0.05).Totally,there were significant differences in mechanical ventilation>24 hour,LCOS,delirium,AKI,nosocomial infections,and the length of stay in ICU between patients with and without nutritional risk(P<0.05):44.09%vs 18.18%,13.98%vs 3.64%,6.45%vs 3.64%,8.60%vs 5.45%,11.83%vs 5.45%,(6.7±1.9)d vs(3.1±1.1)d,P<0.05.Conclusion As the NRS increases,the nosocomial infections,mechanical ventilation>24 hours,LCOS,delirium,AKI,and length of ICU stay gradually increases in the adult patients who underwent mechanical heart valve replacement.