性激素水平对育龄期女性先天性心脏病手术围术期结局影响的回顾性队列研究

Sex hormone levels have little impact on outcomes of cardiac surgery in fertile women with congenital heart disease:A retrospective cohort study

目的调查性激素对先天性心脏病手术围术期结局的影响。方法回顾性分析2015年1月1日—2019年7月30日广东省人民医院先天性心脏病育龄期女性患者的临床资料。首先根据血清孕酮水平将患者分为低孕酮组(n=31)和高孕酮组(n=153),其次根据血清雌激素水平,将患者分为低雌激素组(n=10)、中雌激素组(n=32)和高雌激素组(n=118),月经前注射黄体酮的患者进入黄体酮对照组(n=24)。结果共纳入184例患者,平均年龄(27.6±5.7)岁。其中142例为复杂性先天性心脏病。高孕酮组与低孕酮组相比,术后标准胸腔引流总量和术后白蛋白水平差异有统计学意义(P<0.05),其他围术期结局指标差异无统计学意义(P>0.05)。在不同血清雌激素水平分组中,术后血尿素氮水平、术后标准胸腔引流总量以及住院时间差异有统计学意义(P<0.05),其他围术期结局指标差异无统计学意义(P>0.05)。结论综合临床意义考量,性激素水平的生理变化对先天性心脏病育龄期女性的围术期结局几乎没有影响。

Objective To examine the influence of hormonal fluctuations on the perioperative outcomes of patients undergoing congenital heart surgery.Methods We conducted a retrospective analysis of clinical data from fertile women diagnosed with congenital heart disease at the Guangdong Provincial People's Hospital,between January 1,2015,and July 30,2019.Initially,patients were categorized into groups based on serum progesterone levels:a low progesterone group(n=31)and a high progesterone group(n=153).Furthermore,based on serum estrogen levels,they were divided into a low estrogen group(n=10),a medium estrogen group(n=32),and a high estrogen group(n=118)for comparative analysis.A control group(n=24)consisted of patients who received progesterone injections before their menstrual period.Results We finally included 184 patients.The patients’average age was 27.6±5.7 years,with 142(77.17%)presenting with complex congenital heart conditions.There were statistically significant differences in total postoperative standard thoracic drainage volume and postoperative albumin level between the high and low progesterone groups(P<0.05),while other perioperative outcome indicators showed no statistical differences(P>0.05).Among the different serum estrogen level groups,there were statistically significant differences in postoperative blood urea nitrogen levels,total postoperative standard thoracic drainage volume,and hospital stay(P<0.05),while other perioperative outcome indicators showed no statistical differences(P>0.05).Conclusion Considering the overall clinical significance,the physiological changes in sex hormone levels appear to have a negligible effect on the perioperative outcomes of fertile women with congenital heart disease.