The predictive value of preoperative RDW and PLR in children with congenital heart disease associated with pulmonary arterial hypertension during perioperative period
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摘要: 目的:探索术前红细胞分布宽度(RDW)、血小板淋巴细胞比例(PLR)与先天性心脏病相关肺动脉高压(CHD-PAH)儿童患者接受体外循环(CPB)心脏直视手术后早期预后的关系及其预测机械通气时间延长的临床价值。方法:回顾性分析2012年1月—2018年12月在我科接受CPB正中开胸手术的204例CHD-PAH儿童患者。收集围手术期所有临床数据。分析RDW及PLR与围术期临床指标的相关性,通过绘制ROC曲线评价RDW及PLR水平作为延长机械通气预测指标的可靠性。结果:术前RDW与术前血红蛋白、术前肺动脉收缩压、主动脉阻闭时间、谷草转氨酶、白蛋白、总胆红素、尿酸均显著相关(均P<0.05);术前PLR与术前肺动脉收缩压、CPB时间、主动脉阻闭时间、谷草转氨酶、总胆红素均显著相关(均P<0.05)。术后早期临床结局如机械通气时间、ICU停留时间及总住院时间也与RDW和PLR具有显著相关性(均P<0.05)。ROC曲线分析显示,术前RDW和PLR及联合应用预测机械通气时间分别延长24 h、48 h、72 h的曲线下面积具有统计学意义(均P<0.05)。结论:CHD-PAH儿童患者中,术前RDW及PLR与心脏术后早期并发症及早期临床结局密切相关,并均能在一定程度上预测机械通气时间延长的发生。Abstract: Objective: To explore the relationship between preoperative red blood cell distribution width(RDW) or platelet to lymphocyte ratio(PLR) and early prognosis of children diagnosed as congenital heart disease associated with pulmonary arterial hypertension(CHD-PAH) after cardiopulmonary bypass(CPB) surgery and to investigate their clinical value in predicting prolonged mechanical ventilation. Method: A total of 204 children with CHD-PAH who underwent CPB open heart surgery in our department from January 2012 to December 2018 were analyzed retrospectively. All clinical data during the perioperative period were collected. Correlations between RDW or PLR and perioperative clinical indexes were analyzed, and the reliability of RDW and PLR levels as predictive indexes of prolonged mechanical ventilation were evaluated by ROC curves. Result: Preoperative RDW was significantly correlated with preoperative hemoglobin, preoperative pulmonary artery systolic pressure, aortic clamping time, glutamic oxaloacetic transaminase, albumin, serum total bilirubin, and uric acid(all P<0.05). Preoperative PLR was significantly correlated with preoperative pulmonary artery systolic pressure, CPB time, aortic clamping time, glutamic oxaloacetic transaminase, and serum total bilirubin(all P<0.05). Early postoperative clinical outcomes such as mechanical ventilation time, ICU stay time and total hospital stay time were also significantly correlated with RDW and PLR(all P<0.05). The result of ROC curve analysis showed that there were statistical differences in areas under ROC curve of RDW, PLR and their combination in predicting mechanical ventilation time was prolonged by 24 h, 48 h and 72 h, respectively(all P<0.05).Conclusion: In children with CHD-PAH, preoperative RDW and PLR are closely related to early postoperative complications and early clinical outcomes, and can predict the occurrence of prolonged mechanical ventilation to some extent.
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