心脏瓣膜术后死亡危险因素研究：倾向性评分匹配分析

葛开恒; 刘凌超; 朱雨; 肖颖彬

doi:10.16016/j.1000-5404.202008181

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心脏瓣膜术后死亡危险因素研究：倾向性评分匹配分析

临床医学 | 更新时间：2026-01-09

- 心脏瓣膜术后死亡危险因素研究：倾向性评分匹配分析
- Risk factors for mortality after heart valve surgery: a propensity score matching study
- 第三军医大学学报 2021年43卷第3期页码：244-248
- 作者机构：
  
  400037 重庆, 陆军军医大学(第三军医大学)第二附属医院全军心血管外科研究所
- 作者简介：
  
  [肖颖彬, E-mail: xiaoyb@tmmu.edu.cn XIAO Yingbin, E-mail: xiaoyb@tmmu.edu.cn
- 基金信息：
- DOI：10.16016/j.1000-5404.202008181
  中图分类号： R181.32;R619;R654.2
- 收稿：2020-08-23，
  
  修回：2020-09-17，
  
  纸质出版：2021-02-15
- 稿件说明：
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葛开恒, 刘凌超, 朱雨, 等. 心脏瓣膜术后死亡危险因素研究：倾向性评分匹配分析[J]. 第三军医大学学报, 2021,43(3):244-248.

Kaiheng GE, Lingchao LIU, Yu ZHU, et al. Risk factors for mortality after heart valve surgery: a propensity score matching study[J]. Journal of Third Military Medical University, 2021, 43(3): 244-248.
葛开恒, 刘凌超, 朱雨, 等. 心脏瓣膜术后死亡危险因素研究：倾向性评分匹配分析[J]. 第三军医大学学报, 2021,43(3):244-248. DOI： 10.16016/j.1000-5404.202008181.

Kaiheng GE, Lingchao LIU, Yu ZHU, et al. Risk factors for mortality after heart valve surgery: a propensity score matching study[J]. Journal of Third Military Medical University, 2021, 43(3): 244-248. DOI： 10.16016/j.1000-5404.202008181.

摘要

目的

探讨心脏瓣膜手术后患者死亡的危险因素，指导围术期治疗。

方法

收集我科2016年9月至2019年8月行心脏瓣膜手术患者资料，将术后死亡患者50例纳入死亡组(已排除3例资料不全患者)，另从4 078例心脏瓣膜手术治愈患者中随机选择150例治疗患者纳入对照组。采用倾向性评分匹配方法对两组患者(死亡组、对照组)进行配对，比较两组患者术中失血量、术中肝素用量、术中最低体温、主动脉球囊反搏(intra-aortic ballon pump

IABP)、手术过程、瓣膜类型、术后血气分析结果等临床特征，分析心脏瓣膜术后患者死亡危险因素，并绘制受试者工作(ROC)曲线。

结果

通过倾向性评分匹配出46对患者，死亡组失血量、IABP植入率、术后二氧化碳分压、术后乳酸均高于对照组(

0.05)，死亡组术后氧分压、术后红细胞比容、术后血氧饱和度低于对照组(

0.05)，Logistic回归分析结果显示二氧化碳分压升高、高乳酸血症是心脏瓣膜术后患者死亡危险因素(

0.05)，术后乳酸及二氧化碳分压预测死亡的ROC曲线下面积分别为0.918、0.793，术后乳酸与二氧化碳分压的临界值分别为7.55 mmol/L、49.50 mmHg。

结论

高乳酸血症及二氧化碳分压升高是心脏瓣膜术后死亡的危险因素，术后治疗应该维持充足氧供，改善组织灌注状况以降低死亡风险。

Abstract

Objective

To explore the death risk factors for the patients after heart valve surgery in order to guide the perioperative management.

Methods

A propensity score matching study was performed in the patients undergoing heart valve surgery in our department from September 2016 to August 2019. Fifty dead patients (3 cases without complete clinical data were excluded) were assigned into the death group

and another 150 patients selected from the 4 078 who were recovered after the surgery were assigned into the control group. The clinical data

including intraoperative blood loss

intraoperative heparin dosage

lowest body temperature during cardiopulmonary bypass (CPB)

implantation of intra-aortic balloon pump (IABP)

surgery procedures

type of artificial valve

and results of postoperative blood gas analysis were compared between 2 groups. The death risk factors for these patients were analyzed

and receiver operative characteristic (ROC) curves were drawn to evaluate these factors.

Results

After propensity score matching

46 pairs of patients were finally included. The patients in the death group owned significantly larger intraoperative blood loss

larger number of implanted IABP

higher postoperative PaCO

and lactate levels

while lower hematocrit value and PaO

and SaO

levels when compared with those of the control group (

0.05). The results of logistic regression analysis showed that hyperlactatemia and higher PaCO

were the risk factors for the mortality of valve surgery (

0.05)

and their areas under ROC curves were 0.918 and 0.793

respectively

at the cut-off values of 7.55 mmol/L and 49.50 mmHg

respectively.

Conclusion

Hyperlactatemia and higher PaCO

are risk factors for the mortality of heart valve surgery. Postoperative management should focus on enough oxygen supply and improve tissue perfusion to reduce the mortality risk.

关键词

Keywords

references

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