纤维蛋白原与白蛋白的比值对成人心脏瓣膜术后恢复延迟的预测意义

Predictive significance of the ratio of fibrinogen to albumin in delayed recovery after cardiac valve surgery in adults

目的分析成人心脏瓣膜手术患者术前纤维蛋白原与白蛋白比值(the ratio of fibrinogen to albumin,FAR)与术后恢复情况的相关性。方法收集2019年1~6月在广东省人民医院行心脏瓣膜外科手术的成人患者的临床数据,共234例患者纳入本研究,以术前FAR值等分为三组,分别为低值组(FAR<7.274,共78例)、中值组(7.274≤FAR≤9.064,共78例)和高值组(FAR>9.064,共78例)。通过单因素和多因素logistic回归模型结合受试者工作曲线,分析术前FAR与患者术后恢复情况的相关性。结果多因素logistic回归分析提示,纤维蛋白原与白蛋白的比值每增加一个标准差恢复延迟的发生风险增加138%(OR=2.38,P<0.001);机械通气时间延长的风险增加80%(OR=1.8,P=0.002);与低值组相比,高值组发生恢复延迟的风险增加276%(OR=3.76,P=0.002);机械通气时间延长的风险增加160%(OR=2.6,P=0.046);住院时间延长的风险增加249%(OR=3.49,P=0.008)。术前FAR与术后恢复延迟成线性关系(非线性检验P>0.05)。术后恢复延迟的风险随着术前FAR值的增加而增加(P<0.001)。结论术前纤维蛋白原与白蛋白的比值可有效预测成人心脏瓣膜术后恢复延迟的发生。

Objective To evaluate the association between the preoperative ratio of fibrinogen to albumin(FAR)and postoperative delayed recovery in adult patients underwent cardiac valve surgery.Methods The clinical data of adult patients who underwent cardiac valve surgery at Guangdong Provincial People’s Hospital from January to June 2019 were collected.A total of 234 patients were included.The patients were categorized into three groups based on preoperative FAR values:the group low(FAR<7.274,78 patients),the group middle(7.274≤FAR≤9.064,78 patients)and the group high(FAR>9.064,78 patients).Univariate and multivariate logistic regression and receiver operating characteristic curve were used to explore the association between FAR and delayed recovery.Results Multivariate logistic regression analysis showed that the risk of delayed recovery increased by 138%for every one standard deviation increase in the FAR(OR=2.38,P<0.001).The risk of delayed recovery in the group high was 3.76 times higher than that of the group low(OR=3.76,P=0.002).The risk of prolonged mechanical ventilation in the group high was 2.60 times higher than that in the group low(OR=2.6,P=0.046).The risk of prolonged hospital stay in the group high was 3.49 times higher than that of the group low(OR=3.49,P=0.008).There was a linear relationship between preoperative FAR and postoperative delayed recovery(P>0.05).The risk of delayed recovery increased with preoperative FAR(P<0.001).Conclusion The preoperative FAR could effectively predict the occurrence of postoperative delayed recovery in adults after cardiac valve surgery.