心脏瓣膜置换术后低蛋白血症的危险因素分析

Analysis of Risk Factors for Hypoproteinemia after Heart Valve Replacement

摘要: 目的：分析心脏瓣膜置换术(HVR)后患者发生低蛋白血症的危险因素。方法：回顾分析2021年1月1日至2022年12月31日于青岛大学附属医院心血管外科行心脏瓣膜置换手术患者449例，其中男性229例，女性220例，年龄16~92岁，收集患者临床资料，依据患者术后48小时内白蛋白水平分为低蛋白组(n = 184)和对照组(n = 265)；采用单因素及多因素Logistic回归分析归纳心脏瓣膜置换术后发生低蛋白血症的危险因素，构建多因素预警模型。结果：449例行瓣膜置换手术患者中，术后出现低蛋白血症者184例，单因素回归分析是糖尿病、术前血红蛋白、白蛋白、前白蛋白、体外循环时间、阻断时间、手术时间、术中出血量、自体血回输量、术中胶体量、术中输液量与心脏瓣膜置换术后发生低蛋白血症有关，术前白蛋白水平、体外循环时间、术中出血量、输液量是心脏瓣膜术后低蛋白血症的独立危险因素。结论：术前白蛋白水平、体外循环时间、术中出血量、术中输液量是心脏瓣膜置换术后发生低蛋白血症的危险因素。

Abstract: Objective: Analyzing risk factors for the development of hypoproteinemia in patients after heart valve replacement (HVR). Methods: A retrospective analysis of 449 patients who underwent heart valve replacement surgery at the Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, from 1 January 2021 to 31 December 2022, including 229 males and 220 females aged 16~92 years old. The clinical data of the patients were collected, and they were divided into a low-protein group (n = 184) and a control group (n = 265) based on the level of albumin in the postoperative period of 48 hours; single-factor and multifactorial logistic models were used to analyse the risk factors for hypoproteinaemia and its warning model. Single-factor and multifactor logistic regression analyses were used to summarise the risk factors for the occurrence of hypoproteinaemia after heart valve replacement, and a multifactor early warning model was constructed. Results: Among the 449 patients who underwent valve replacement surgery, there were 184 cases of postoperative hypoproteinaemia, and the univariate regression analysis was that diabetes mellitus, preoperative haemoglobin, albumin, prealbumin, time of extracorporeal circulation, time of blocking, time of surgery, intraoperative bleeding volume, autologous blood refill volume, intraoperative colloid volume, and intraoperative infusion volume were related to the occurrence of hypoproteinaemia after heart valve replacement, and the preoperative albumin level, extracorporeal circulation time, intraoperative bleeding volume, and fluid infusion volume were independent risk factors for postoperative hypoproteinaemia after heart valve surgery. Conclusion: Preoperative albumin level, duration of extracorporeal circulation, intraoperative bleeding, and intraoperative fluid infusion are risk factors for hypoproteinaemia after heart valve replacement.