摘要
目的 基于倾向性评分匹配法(PSM)均衡混杂因素,分析风湿性心脏病(RHD)心脏瓣膜置换术后并发下肢深静脉血栓形成(DVT)的危险因素.方法 回顾性分析2018年1月至2023年1月于安阳市人民医院心脏大血管外科行心脏瓣膜置换术的389例RHD患者的临床资料,根据术后1周内是否并发下肢DVT其分为并发组(n=35)和未并发组(n=354).以1︰2比例运用PMS将两组性别、年龄、体质指数(BMI)、吸烟史、饮酒史、RHD病程、病变类型、瓣膜材料、置换位置、纽约心脏协会(NYHA)分级、基础病史等基线资料进行匹配.比较两组匹配前后的基线资料,匹配后通过多因素Logistic回归分析法分析RHD患者心脏瓣膜置换术后并发下肢DVT的危险因素.结果 匹配前,两组性别、年龄、BMI、RHD病程、瓣膜材料、糖尿病史、高血脂史、心房颤动史比较,差异均有统计学意义(P<0.05),吸烟史、饮酒史、病变类型、置换位置、NYHA分级、高血压史等比较,差异均无统计学意义(P>0.05);经PSM处理后,并发组得到32例RHD患者,未并发组得到64例RHD患者,两组性别、年龄、BMI、吸烟史、饮酒史、RHD病程、病变类型、瓣膜材料、置换位置、NYHA分级、基础病史等比较差异均无统计学意义(P>0.05);匹配后,并发组术前血小板计数、D-二聚体(D-D)水平、凝血四项异常占比、三酰甘油(TG)水平、手术时长、术后当天国际标准化比值、华法林剂量、术后卧床天数均高于未并发组(P<0.05).多因素Logistic回归分析结果显示,术前高血浆D-D水平、凝血四项异常、高血小板计数、高TG水平、长手术时长、高华法林剂量、术后长卧床天数均为RHD患者心脏瓣膜置换术后并发下肢DVT的危险因素(P<0.05);术前血浆D-D>395.25 ng/ml、血小板计数>312.22×109/L、TG>1.94 mmol/L时RHD患者心脏瓣膜置换术后并发下肢DVT的曲线下面积分别为0.799、0.777、0.813.结论 经PSM均衡基线资料后,术前血浆D-D水平、凝血四项异常、血小板计数、TG、手术时长、华法林剂量、术后卧床天数均为RHD患者心脏瓣膜置换术后并发下肢DVT的影响因素.
Abstract
Objective To analyzed the risk factors of lower extremity deep vein thrombosis (DVT) after cardiac valve replacement for rheumatic heart disease (RHD) based on balance confounding factors of propensity score matching (PSM).Methods The clinical materials were retrospectively analyzed in RHD patients (n=389) undergone cardiac valve replacement in Department of Cardiac-Vascular Surgery of People's Hospital of Anyang City from Jan.2018 to Jan.2023.The patients were divided,according to whether they complicated by lower extremity DVT or not within 1 week after the operation,into DVT group (n=35) and non-DVT group (n=354).The baseline materials were matching in a 1︰2 ratio by using PMS,including gender,age,body mass index (BMI),history of smoking and drinking,RHD course,lesion type,valve material,replacement location,NAHY heart function classification and basic disease history.The baseline materials were compared between 2 groups before and after matching.After matching,the risk factors of lower extremity DVT were analyzed by using multi-factor Logistic regression analysis in RHD patients after cardiac valve replacement.Results Before matching,the differences in gender,age,BMI,RHD course,valve material and history of diabetes,hyperlipidemia and atrial fibrillation (AF) had statistical significance (P＜0.05),and the differences in history of smoking and drinking,lesion type,replacement location,NYHA heart function classification and hypertension history had no statistical significance (P＞0.05) between 2 groups.After PSM,there were 32 RHD patients in DVT group and 64 RHD patients in non-DVT group.The differences in gender,age,BMI,history of smoking and drinking,RHD course,lesion type,valve material,replacement location,NYHA heart function classification and basic disease history had no statistical significance (P＞0.05) between 2 groups.After matching,preoperative platelet count (PLT),level of plasma D-dimer (D-D),proportion of abnormal 4 items of coagulation tests,level of triglyceride (TG),operation duration,international normalized ratio (INR) on the right postoperative day,warfarin dose and postoperative bed rest days were higher in DVT group than those in non-DVT group (P＜0.05).The results of multi-factor Logistic regression analysis showed that higher preoperative D-D level,abnormal 4 items of coagulation tests,higher levels of PLT and TG,longer operation duration,higher warfarin dose and longer postoperative bed rest days were risk factors of lower extremity DVT in RHD patients after cardiac valve replacement (P＜0.05).When preoperative D-D＞395.25 ng/ml,PLT＞312.22×109/L and TG＞1.94 mmol/L,AUC was,respectively,0.799,0.777 and 0.813 in RHD patients after cardiac valve replacement.Conclusion After PSM for baseline material balance,preoperative plasma D-D level,abnormal 4 items of coagulation tests,PLT,TG level,operation duration,warfarin dose and postoperative bed rest days are influence factors in RHD patients complicated by lower extremity DVT after cardiac valve replacement.
维普
万方数据