CAJ | 학술논문

目的探讨老年患者心脏瓣膜置换术后低心排综合征的相关危险因素.方法通过巢式病例对照研究的方法,以年龄≥60岁且行心脏瓣膜置换术患者作为研究队列.根据研究对象在手术术后是否出现低心排综合征分为病例组(n=45)和对照组(n=234).上述两组均进行临床资料收集,先对相关数据进行单因素分析,再进行两分类Logistic回归分析.结果单因素分析表明,术前动脉压、肾功能不全情况；术中主动脉阻断时间、出血量；术后并发电解质失调、心律失常或多器官功能衰竭等方面组间差异有统计学意义(P＜0.05).两分类Logistic回归分析表明,失血量/总血容量[比值比(OR)=0.32,P＜0.05]、主动脉阻断时间(OR=1.85,P＜0.05)、电解质失调(OR=1.43,P＜0.05)、心律失常(OR=1.61,P＜0.05)为心脏瓣膜置换术后出现低心排综合征的危险因素.结论患者术前平均动脉压低、术中主动脉阻断时间长、出血量多及术后出现电解质失调、心律失常、多个器官衰竭情况均为老年患者心脏瓣膜置换术后出现低心排综合征的影响因素,其中主动脉阻断时间、术中出血量、术后出现心律失常及电解质失调等是重要危险因素.
목적 탐토노년환자심장판막치환술후저심배종합정적상관위험인소.방법 통과소식병례대조연구적방법,이년령≥60세차행심장판막치환술환자작위연구대렬.근거연구대상재수술술후시부출현저심배종합정분위병례조(n=45)화대조조(n=234).상술량조균진행림상자료수집,선대상관수거진행단인소분석,재진행량분류Logistic회귀분석.결과 단인소분석표명,술전동맥압、신공능불전정황；술중주동맥조단시간、출혈량；술후병발전해질실조、심률실상혹다기관공능쇠갈등방면조간차이유통계학의의(P＜0.05).량분류Logistic회귀분석표명,실혈량/총혈용량[비치비(OR)=0.32,P＜0.05]、주동맥조단시간(OR=1.85,P＜0.05)、전해질실조(OR=1.43,P＜0.05)、심률실상(OR=1.61,P＜0.05)위심장판막치환술후출현저심배종합정적위험인소.결론 환자술전평균동맥압저、술중주동맥조단시간장、출혈량다급술후출현전해질실조、심률실상、다개기관쇠갈정황균위노년환자심장판막치환술후출현저심배종합정적영향인소,기중주동맥조단시간、술중출혈량、술후출현심률실상급전해질실조등시중요위험인소.
Objective To investigate the related risk factors of low cardiac output syndrome after heart valve replacement in elderly patients.Patients were divided into case group (n =45) and control group (n =234) according to whether they suffered from low cardiac output syndrome after surgery or not.We collected clinical information among the patients and utilized Univariate analysis,chi-square test and ttest to analyze data,and then used two classification logistic regression analysis to analyze the risk factors which having significant difference in the univariate analysis.Results Univariate analysis showed that preoperative mean arterial pressure,renal insufficiency situation,intraoperative aortic clamping time and the volume of blood loss,postoperative electrolyte imbalance,cardiac arrhythmias and multiple organ failure all had statistically significant differences between two groups (P ＜ 0.05).Two classification logistic regression analysis showed that blood loss/total blood volume [odds ratio(OR) =0.32,P ＜ 0.05],aortic clamp time (OR =1.85,P ＜ 0.05),electrolyte disorders (OR =1.43,P ＜ 0.05),arrhythmia (OR =1.61,P ＜ 0.05) are all the risk factors for low cardiac output syndrome after heart valve replacement surgery.Conclusion Preoperative mean arterial blood pressure,intraoperative aortic clamping time,the amount of blood loss and postoperative electrolyte imbalance,cardiac arrhythmias,and multiple organ failure are all the factors which can affect elderly patients with heart valve replacement surgery emerged low cardiac output syndrome or not,among which aortic clamping time,blood loss,postoperative cardiac arrhythmias and electrolyte imbalance are the important risk factors.