【摘要】 目的:分析心脏瓣膜置换术后发生低心排血量综合征(LCOS)的临床危险因素及潜在病因,为临床防治提供依据。方法:回顾性分析行瓣膜置换并有Swan-Ganz导管监测的386例患者,将其分为LCOS组和无LCOS组,对发生LCOS的相关危险因素进行多因素logistic回归分析。结果:术后发生LCOS共108例(28.0%),无LCOS278例(72.0%);年龄、术前是否有高血压、糖尿病、心律失常病史、瓣膜置换方式在2组间无明显差异(P>0.05);LCOS组术前体重指数小于非LCOS组,而心胸比、脑钠肽(BNP)、肺动脉压力(PAP)、欧洲心血管手术危险因素评分系统高于后者,术中的体外循环(CPB)时间、主动脉阻断时间长于非LCOS组,术后的出血量、二次手术例数也多于非LCOS组(均P<0.05);多因素logistic回归分析表明术前BNP>600pg/mL、体重指数<18kg/m2、心胸比>0.7、PAP>65mmHg、CPB时间>120min、主动脉阻断时间>60min和术后出血量>20%总血容量是心脏瓣膜病术后发生LCOS的独立危险因素。结合Swan-Ganz导管监测数据和床边心脏超声等辅助检查分析发现,有62例(57.4%)因前负荷不足、36例(33.3%)因泵功能衰竭、6例(5.6%)因心脏压塞、4例(3.7%)因心律失常导致术后的LCOS。结论:术前心功能差、低体重、心胸比>0.7、肺动脉高压、体外循环时间及主动脉阻断时间长,术后出血量多是心脏瓣膜病术后发生LCOS的危险因素;导致LCOS的主要原因有前负荷不足、泵功能衰竭、心脏压塞和心律失常。更多还原

【Abstract】 Objective: To analyze the clinical risk factors and potential etiologies of low cardiac output syndrome (LCOS) after heart valve replacement, and to provide the evidence for the clinical prevention and treatment. Methods: Three hundred and eighty-six patients with Swan-Ganz catheter monitoring after heart valve replacement were studied retrospectively, and they were divided into LCOS group and non-LCOS group. The risk factors related with LCOS in all cases were analyzed by logistic regression analysis. Results: One hundred and eight patients (28.0%)developed LCOS, while another 278 patients (72.0%) did not. There were no obvious differences in age, preoperative hypertension, diabetes, history of arrhythmia and way of valve replacement (P>0.05). The preoperative body mass index of LCOS group was less than that of non-LCOS group, the cardiothoracic ratio, brain natriuetic peptide(BNP)and pulmonary arterial pressure(PAP), EuroSCORE rating were higher in LCOS group than those in non-LCOS group. The time of cardiopulmonary bypass and intraoperative aortic clamping were longer than those of non-LCOS group. The volume of postoperative blood loss and the subsequent second surgery were also more than those of non-LCOS group (P< 0.05). Retrospective study demonstrated that preoperative BNP>600 pg/mL, body mass index<18 kg/m2, cardiothoracic ratio>0.7, PAP>65 mmHg, the time of CPB>120 minutes, the time of aortic clamping>60 minutes and postoperative blood loss > 20% of total blood volume were the independent risk factors of developing LCOS after heart valve replacement. Combined with Swan-Ganz catheter monitoring data and auxiliary examination, such as bedside echocardiograph, we found that 62 cases (57.4%) with insufficient preload, 36 cases (33.3%) with pumping function failure, 6 patients (5.6%) with cardiac tamponade, 4 cases (3.7%) with arrhythmia leaded to postoperative LCOS. Conclusions: Preoperative heart failure, low body weight, cardiothoracic ratio>0.7, pulmonary hypertension, the prolonged time of extracorporeal circulation and aortic clamping, massive blood loss are the risk factors of LCOS; preexisted load deficiency, heart failure, cardiac tamponade and arrhythmia are the main causes of LCOS.更多还原