CAJ | 학술논문

目的探讨心脏瓣膜病换瓣术后发生低心排血量综合征的危险因素,为制定低心排血量综合征的防治措施提供依据.方法采用前瞻性病例对照研究和非条件Logistic多元回归分析方法,选择宜昌市第一人民医院重症医学科2008年1月至2013年5月收治的心脏瓣膜病换瓣术后的96例患者,发生低心排血量综合征41例作为观察组,无低心排血量综合征55例作为对照组.对潜在危险因素进行对比分析,并采用非条件Logistic多元回归分析找出其独立危险因素.结果心脏瓣膜病换瓣术后发生低心排血量综合征患者41例,发生率为42.7％.单因素分析结果显示:肝脏肿大(P =0.007)、病程≥15年(P=0.042)、体外循环时间≥120 min(x2=3.937,P=0.047)、术前心功能不全≥Ⅲ级(P=0.003)为心脏瓣膜病换瓣术发生低心排血量综合征的危险因素.Logistic多因素回归分析显示,心脏瓣膜病换瓣术后发生低心排血量综合征的独立危险因素是:病程≥15年(OR=2.825,95％ CI为1.015～7.861,P=0.047)、术前心功能不全≥Ⅲ级(OR =7.306,95％CI为2.050～ 26.035,P=0.002).结论病程≥15年和术前心功能不全≥Ⅲ级是心脏瓣膜病换瓣术后发生低心排血量综合征的独立危险因素.
목적 탐토심장판막병환판술후발생저심배혈량종합정적위험인소,위제정저심배혈량종합정적방치조시제공의거.방법 채용전첨성병례대조연구화비조건Logistic다원회귀분석방법,선택의창시제일인민의원중증의학과2008년1월지2013년5월수치적심장판막병환판술후적96례환자,발생저심배혈량종합정41례작위관찰조,무저심배혈량종합정55례작위대조조.대잠재위험인소진행대비분석,병채용비조건Logistic다원회귀분석조출기독립위험인소.결과 심장판막병환판술후발생저심배혈량종합정환자41례,발생솔위42.7％.단인소분석결과현시:간장종대(P =0.007)、병정≥15년(P=0.042)、체외순배시간≥120 min(x2=3.937,P=0.047)、술전심공능불전≥Ⅲ급(P=0.003)위심장판막병환판술발생저심배혈량종합정적위험인소.Logistic다인소회귀분석현시,심장판막병환판술후발생저심배혈량종합정적독립위험인소시:병정≥15년(OR=2.825,95％ CI위1.015～7.861,P=0.047)、술전심공능불전≥Ⅲ급(OR =7.306,95％CI위2.050～ 26.035,P=0.002).결론 병정≥15년화술전심공능불전≥Ⅲ급시심장판막병환판술후발생저심배혈량종합정적독립위험인소.
Objective To find out the risk factors of postoperative low cardiac output syndrome(LCOS) of patients undergoing cardiac valvular surgery in ICU in order to provide basic for prevention and control measures.Methods Ninety-six valve replacement patients with valvular heart disease were enrolled as our subjects and they were hospitalized in ICU of the First People's hospital of Yichang from Jan.2008 to May.2013.The patients postoperative LCOS (Dopamine ＞ 10 μg/(kg · min)) were served as observation group (n =41),and the other were control groups(n =55).All data of the patients were recorded.Non-conditions Logistic regressions analysis were adopted to analyze the independent risk factors which resulted in LCOS undergoing cardiac valvular surgery.Results Of 96 patients undergoing cardiac vavular surgery,41cases (42.7％) had postoperative LCOS.Single factor analysis showed that hepatomegaly (P =0.007),course of diseases ≥ 15 years (P =0.042),cardiopulmonary bypass ≥ 120 min (x2 =3.937,P =0.047),pre-operative cardiac function ≥ Ⅲ degree (P =0.003) were the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery.The Logistic multi factor regression analysis showed that the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery included course of diseases ≥ 15 years (OR =2.825,95％ CI =(1.015-7.861)),Pre-operative cardiac function ≥ Ⅲ degree (OR =7.306,95％ CI =(2.050-26.035),P=0.002).Conclusion Course of diseases ≥15 years and Pre-operative cardiac function≥ Ⅲ-Ⅳ degree are the independent risk factors of LCOS undergoing cardiac valvular surgery.