二尖瓣关闭不全患者心脏瓣膜置换术后发生低心排综合征的相关因素及预测模型构建

doi:10.3969/j.issn.1006-6233.2022.02.024

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Abstract Objective: To analyze the related factors of low cardiac output syndrome (LCOS) in patients with mitral regurgitation (MR) after cardiac valve replacement (CVR), and to build the prediction model. Methods: A total of 163 patients with MR admitted to our hospital from January 2018 to December 2020 were selected as the research subjects. The baseline data of patients were recorded. All patients were treated with CVR. The operation related data were recorded, and the occurrence of LCOS was counted. The patients were divided into LCOS group and non-LCOS group. The baseline data and operation related data were compared between the two groups. Logistic regression analysis was used to examine the risk factors of LCOS in patients with MR after CVR; the LCOS prediction model was built. Hosmer-Lemeshow goodness-of-fit test was used, and the ROC curve was plotted, to evaluate the prediction efficiency of LCOS prediction model. Results: Among 163 MR patients in this study, LCOS occurred in 28 patients after CVR treatment, the incidence was 17.18%; the proportions of New York Heart Association (NYHA) classification, preoperative B-type natriuretic peptide (BNP), preoperative cardiac troponin T (cTnT) and water electrolyte disturbance in LCOS group were higher than those in non-LCOS group; cardiopulmonary bypass (CPB) time and aortic occlusion (ACC) time were longer than those in non-LCOS group; the postoperative blood loss was greater than that in non-LCOS group, and the preoperative LVEF was lower than that in non-LCOS group (P<0.05); the results of logistic regression analysis showed that high NHYA grade, low preoperative LVEF, high preoperative BNP, high preoperative cTnT, disturbance of water and electrolyte, long CPB time, long ACC time and large postoperative blood loss were risk factors for LCOS after CVR in MR patients (OR>1, P<0.05). The predictive model LCOS=0.951*NHYA classification (grade II=0, grade III=1)-0.179* preoperative LVEF + 0.015* preoperative BNP+3.869 * preoperative cTnT+1.014 * water electrolyte disorder (no=0, yes=1)+0.084 * CPB time+0.129 * ACC time+0.298 * postoperative blood loss was established, with the predictive risk value P=e (-17.813+LCOS)/[e (-17.813+LCOS)+1]*100%. The receiver operating curve (ROC) was plotted which showed that the AUC of LCOS prediction model for predicting the risk of LCOS after CVR in MR patients was 0.895, >0.80, which had certain predictive value; the LCOS prediction model tested by Hosmer-Lemeshow goodness-of-fit test found that χ²=3.324, P=0.912, P>0.05, the model had good correction ability and satisfactory fitting. Conclusion: The occurrence of LCOS after CVR in MR patients is affected by multiple risk factors. Combined with multiple risk factors, the LCOS prediction model is built, which has certain efficiency in predicting the LCOS of MR patients after CVR.

Key words： Mitral regurgitation Cardiac valve replacement Low cardiac output syndrome

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	LI Ling
	LIU Zunji
	GUO Yongzhong

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LI Ling,LIU Zunji,GUO Yongzhong. Related Factors of Low Cardiac Output Syndrome in Patients with Mitral Regurgitation After Cardiac Valve Replacement and the Construction of Prediction Model[J]. HeBei Med, 2022, 28(2): 295-301.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2022.02.024 OR http://www.hbyxzzs.cn/EN/Y2022/V28/I2/295

[1] Rahman SM,Sazzad F,Wadud MA,et al.Low cardiac output syndrome:incidence after mitral valve replacement with or without preservation of mitral valve apparatus[J].Mymensingh Med,2021,30(1):164~170.
[2] El Hadj Sidi C,Mgarrech I,Tarmiz A,et al.External validation of the european system for cardiac operative risk evaluation II in a tunisian population[J].Card Surg,2019,34(5):266~273.
[3] Caraballo C,Desai NR,Mulder H,et al.Clinical implications of the new york heart association classification[J].Am Heart Assoc,2019,8(23):e014240.
[4] Apfelbaum JL,Connis RT.The american society of anesthesiologists practice parameter methodology[J].Anesthesiology,2019,130(3):367~384.
[5] 林果为,王吉耀,葛均波.实用内科学[M].北京:人民出版社,2017.1020~1022.
[6] 中国心血管健康联盟中国心脏瓣膜病介入中心委员会.中国心脏瓣膜病介入中心标准1.0(认证和建设标准)[J].中国介入心脏病学杂志,2021,29(1):4~8.
[7] 张海涛,杜雨,曹芳芳,等.低心排血量综合征中国专家共识[J].解放军医学杂志,2017,42(11):933~944.
[8] 高敏.心脏瓣膜置换术后低心排综合征危险因素的调查分析[J].护理实践与研究,2020,17(22):67~69.
[9] Sanfilippo F,Knight JB,Scolletta S,et al.Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery:a systematic review and meta-analysis[J].Crit Care,2017,21(1):252.
[10] Zhang B,Xu H,Zhang H,et al.Prognostic value of N-terminal pro-B-type natriuretic peptide in elderly patients with valvular heart disease[J].Am Coll Cardiol,2020,75(14):1659~1672.
[11] Natale M,Behnes M,Kim SH,et al.High sensitivity troponin T and I reflect mitral annular plane systolic excursion being assessed by cardiac magnetic resonance imaging[J].Eur Med Res,2017,22(1):38.
[12] Mozenska O,Bil J,Segiet A,et al.The influence of calcium-phosphate metabolism abnormalities on the quality of life in patients with hemodynamically significant mitral regurgitation[J].BMC Cardiovasc Disord,2019,19(1):116.
[13] 刘文俊,陈应富,唐杨,等.先天性心脏病术后脑组织氧饱和度与其预后的相关性分析[J].重庆医科大学学报,2018,43(11):1508~1512.
[14] Gordon-Evans WJ,Carney JP,Lahti MT,et al.Pilot study investigating the feasibility of mitral valve repair without aortic cross-clamping and cardioplegia[J].Can Vet Res,2020,84(2):159~162.
[15] Dos Santos ER,Lopes CT,Maria VL,et al.Risk factors for decreased cardiac output after coronary artery bypass grafting:a prospective cohort study[J].Eur Cardiovasc Nurs,2017,16(4):352~359.