| Objective:To explore the clinical value of neutrophil/lymphocyte ratio(NLR)in patients with rheumatic heart disease with double valve replacement during perioperative period,in order to find a convenient,cheap and efficient operation for clinicians Risk assessment indicators,through the development of appropriate preventive measures in advance,bring more benefits to patients with rheumatic heart disease.Method:Retrospectively analyze these 82 patients with rheumatic heart valve disease who underwent double valve replacement in cardiothoracic surgery in our hospital from October 2017 to November 2019,including 30 males and 52 females,Aged 34-70 years,mean age(51.21±7.38 years).We use a stratified approach.Taking the median value of preoperative NLR as the boundary,the patients were divided into high NLR group and low NLR group.All patients were treated with aortic valve replacement and mitral valve replacement after the cardiac reserve function was adjusted by drugs.Some patients underwent tricuspid angioplasty and radiofrequency ablation at the same time.Compare differences in various indicators such as preoperati-ve general information,mitral and aortic valve area,postoperative NLR value,extracorporeal circulation time,aortic occlusion time,operation time,total 24-hour drainage,mechanical ventilation time,ICU stay time,postoperative hospital stay time,complication rate,and in-hospital mortalitytime.SPSS 21.0 software was used for statistical analysis.Measuring data were tested by two-sample t-test,and non-parametric rank-sum test was used when the conditions were not met;counting data were compared between groups using chi-square test.Multivariate correlation analysis was performed on the statistically significant indicators in the univariate results using a binary logistic regression model.P<0.05 indicated that the difference was statistically significant.The ROC curve was drawn with in-hospital death as the outcome to analyze the predictive value of perioperative NLR for in-hospital death in patients with rheumatic heart disease undergoing double valve replacement.Result:Preoperative general information,cardiopulmonary bypass time(P=0.089),aortic occlusion time(P=0.083),operation time(P=0.194),total 24-hour drainage(P=0.075),and mechanical ventilation Time(P=0.682),ICU stay time(P=0.221),pulmonary infection(P=0.109),liver dysfunction(P=0.240),ventricular arrhythmia(P=0.177),stroke(P=0.644),Second thoracotomy,there was no significant difference in both groups(P>0.05);mitral valve area(P=0.010),aortic valve area(P=0.048),postoperative NLR P=0.026),low cardiac output syndrome(P=0.023),incidence of acute kidney injury(P=0.026),postoperative hospital stay(P=0.013),complication rate(P=0.034),in-hospital death Rate(P=0.048),the difference was statistically significant in both groups(P<0.05);Logistic regression results showed that pre-operative NLR was an independent risk of postoperative NLR and complication rate Factors,that is,the higher the preoperative NLR,the higher the postoperative NLR and the incidence of complications;while the mitral valve orifice area and aortic valve orifice area are significantly negatively related to the preoperative NLR level,that is,the higher the preoperative NLR The smaller mitral valve orifice area and aortic valve orifice area;the ROC curve shows that the best critical point for predicting in-hospital death before surgery is 2.2,the sensitivity is 85.7%,the specificity is 60.0%,and the area under the corresponding curve(AUC)is 0.727;The optimal cut-off point for predicting in-hospital death after surgery was 14.28,the sensitivity was 57.1%,the specificity was 86.7%,and the area under the corresponding curve(AUC)was 0.759.Conclusion:The higher the preoperative NLR value of patients with rheumatic heart disease,the worse the degree of valve stenosis,the higher the incidence of postoperative complications,and the longer the hospital stay.The perioperative NLR value can be used as one of the important predictors of in-hospital mortality in patients with rheumatic heart disease with double valve replacement. |
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