摘要
目的:探讨心脏瓣膜置换术后心律失常及低心排综合征(LCOS)发生的影响因素。方法:选择空军军医大学第一附属医院心血管外科2021年3月—2024年3月收治的心脏瓣膜置换术后同时发生心律失常和LCOS的患者58例为并发症组,另选取同期心脏瓣膜置换术后无并发症患者265例为无并发症组。记录两组一般资料、术前心脏彩色超声指标、实验室指标及手术相关指标。采用logistic回归模型分析心脏瓣膜置换术后发生心律失常及LCOS的相关危险因素,采用ROC曲线评估预测指标对心脏瓣膜置换术后发生心律失常及LCOS的预测价值。结果:多因素logistic回归分析结果显示,年龄(OR=3.459)、心胸比(OR=2.559)、冠心病史(OR=3.040)、左心室射血分数(OR=2.434)、体外循环时间(OR=3.126)、主动脉阻断时间(OR=2.225)是患者心脏瓣膜置换术后发生心律失常及LCOS的独立危险因素(均P<0.05)。ROC分析显示,年龄、心胸比、冠心病史、左心室射血分数、体外循环时间和主动脉阻断时间联合预测术后心律失常及LCOS发生的曲线下面积为0.766(95%CI:0.697~0.835),灵敏度为0.586,特异度为0.800。结论:年龄、心胸比、冠心病史、左心室射血分数、体外循环时间和主动脉阻断时间是患者术后发生心律失常及LCOS的独立危险因素,其联合预测价值较高。
Objective To explore risk factors for arrhythmia and low cardiac output syndrome (LCOS) after heart valve replacement.Methods A total of 58 patients who experienced both arrhythmia and LCOS after heart valve replacement at the Department of Cardiovascular Surgery, First Affiliated Hospital of Air Force Medical University from March 2021 to March 2024 were included in the complication group, while 265 patients without postoperative complications during the same period were assigned to the non-complication group. General clinical data, pre-operative cardiac ultrasound parameters, laboratory indices, and surgical-related indicators were recorded. Logistic regression analysis was performed to identify independent risk factors for postoperative arrhythmia and LCOS. ROC curves were used to evaluate the predictive value of these factors.Results Multivariate analysis revealed that age(OR=3.459), cardiothoracic ratio (OR=2.559), history of coronary artery disease (OR=3.040), left ventricular ejection fraction (OR=2.434), cardiopulmonary bypass time (OR=3.126), and aortic cross-clamp time (OR=2.225) were independent risk factors for postoperative arrhythmia and LCOS (all P < 0.05). ROC analysis indicated that the combination of age, cardiothoracic ratio, coronary artery disease history, left ventricular ejection fraction, cardiopulmonary bypass time, and aortic cross-clamp time had an area under the curve (AUC) of 0.766 (95%CI: 0.697-0.835) for predicting postoperative arrhythmia and LCOS, with a sensitivity of 0.586 and a specificity of 0.800.Conclusion Age, cardiothoracic ratio, coronary artery disease history, left ventricular ejection fraction, cardiopulmonary bypass time, and aortic cross-clamp time are independent risk factors for postoperative arrhythmia and LCOS. Their combined use provides high predictive value.
作者
倪迎
胡颖
张霍
王立
NI Ying;HU Ying;ZHANG Huo;WANG Li(Department of Cardiovascular Surgery,The First Affiliated Hospital of PLA Air Force Medical University,Xi'an,710032,China;Department of Pediatric Stomatology,The Third Affiliated Hospital of PLA Air Force Medical University)
出处
《临床心血管病杂志》
2025年第7期560-565,共6页
Journal of Clinical Cardiology
基金
陕西省自然科学基础研究项目(No:2024JC-YBMS-635)
西京医院学科助推计划(No:XJZT24LY26)。
